Provider Demographics
NPI:1568673929
Name:HICKS, GLENDA K (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:K
Last Name:HICKS
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-3826
Mailing Address - Country:US
Mailing Address - Phone:409-385-3510
Mailing Address - Fax:409-386-5751
Practice Address - Street 1:1005 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-3826
Practice Address - Country:US
Practice Address - Phone:409-385-3510
Practice Address - Fax:409-386-5751
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist