Provider Demographics
NPI:1518094036
Name:GLEESON, CHARITY LYNNE (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:LYNNE
Last Name:GLEESON
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:MISS
Other - First Name:CHARITY
Other - Middle Name:LYNNE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:573 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:RIVA
Mailing Address - State:MD
Mailing Address - Zip Code:21140-1034
Mailing Address - Country:US
Mailing Address - Phone:410-956-0188
Mailing Address - Fax:
Practice Address - Street 1:140 STEPNEY LN
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2801
Practice Address - Country:US
Practice Address - Phone:410-956-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02419OtherSTATE LICENSE FOR OT