Provider Demographics
NPI:1447737986
Name:GLOVER, TANISHA ASHLEY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:ASHLEY
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 1:2310 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-4549
Mailing Address - Country:US
Mailing Address - Phone:757-513-5258
Mailing Address - Fax:
Practice Address - Street 1:2310 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-4549
Practice Address - Country:US
Practice Address - Phone:757-513-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001849224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant