Provider Demographics
NPI:1447424379
Name:GRAFFITTI-GLASS, ARLENE MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:MARIE
Last Name:GRAFFITTI-GLASS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 KERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1328
Mailing Address - Country:US
Mailing Address - Phone:317-513-1866
Mailing Address - Fax:317-580-0379
Practice Address - Street 1:9450 KERWOOD DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1328
Practice Address - Country:US
Practice Address - Phone:317-513-1866
Practice Address - Fax:317-580-0379
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002651A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist