Provider Demographics
NPI:1467662619
Name:FAZIO, GLENYS DIANE (OTR)
Entity Type:Individual
Prefix:MS
First Name:GLENYS
Middle Name:DIANE
Last Name:FAZIO
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 1:5320 SUMMERWIND DR
Mailing Address - Street 2:103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-5998
Mailing Address - Country:US
Mailing Address - Phone:239-588-0055
Mailing Address - Fax:239-325-8606
Practice Address - Street 1:5320 SUMMERWIND DR
Practice Address - Street 2:103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-5998
Practice Address - Country:US
Practice Address - Phone:239-588-0055
Practice Address - Fax:239-325-8606
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12055225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist