Provider Demographics
NPI:1497365993
Name:GLUM, OLIVIA RACHEL
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RACHEL
Last Name:GLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 1/2 S JULIA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-5345
Mailing Address - Country:US
Mailing Address - Phone:516-606-3996
Mailing Address - Fax:
Practice Address - Street 1:1128 BEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5769
Practice Address - Country:US
Practice Address - Phone:267-316-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician