Provider Demographics
NPI:1184030561
Name:GLOVER, LAURIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTHPOINTE CIR
Mailing Address - Street 2:102
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7861
Mailing Address - Country:US
Mailing Address - Phone:724-831-5042
Mailing Address - Fax:
Practice Address - Street 1:401 W AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-1445
Practice Address - Country:US
Practice Address - Phone:419-825-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04124224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant