Provider Demographics
NPI:1174844419
Name:GLUCK, ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BROADWAY
Mailing Address - Street 2:SUITE #908
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2608
Mailing Address - Country:US
Mailing Address - Phone:212-473-0011
Mailing Address - Fax:212-473-0009
Practice Address - Street 1:611 BROADWAY
Practice Address - Street 2:SUITE #908
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2608
Practice Address - Country:US
Practice Address - Phone:212-473-0011
Practice Address - Fax:212-473-0009
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015614225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist