Provider Demographics
NPI:1568534113
Name:GLICK, LINDA IRENE (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:IRENE
Last Name:GLICK
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 LAKE OTIS PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-563-8318
Mailing Address - Fax:907-563-3472
Practice Address - Street 1:4015 LAKE OTIS PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-563-8318
Practice Address - Fax:907-563-3472
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKOT339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist