Provider Demographics
NPI:1336325190
Name:GLASS, TANYA ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ANNE
Last Name:GLASS
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 1:2941 ARIEL DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2258
Mailing Address - Country:US
Mailing Address - Phone:775-232-1419
Mailing Address - Fax:
Practice Address - Street 1:2941 ARIEL DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2258
Practice Address - Country:US
Practice Address - Phone:775-232-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0542225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics