Provider Demographics
NPI:1518492842
Name:MCGLOCKTON, ALTRIMESE
Entity Type:Individual
Prefix:
First Name:ALTRIMESE
Middle Name:
Last Name:MCGLOCKTON
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 1:97 N JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-3102
Mailing Address - Country:US
Mailing Address - Phone:504-453-6473
Mailing Address - Fax:
Practice Address - Street 1:97 N JOHNSON RD
Practice Address - Street 2:
Practice Address - City:SUMMERLAND KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-3102
Practice Address - Country:US
Practice Address - Phone:504-453-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist