Provider Demographics
NPI:1568955789
Name:GLASGO, PAULA CAROLE
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:CAROLE
Last Name:GLASGO
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 1:4205 ROME SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8668
Mailing Address - Country:US
Mailing Address - Phone:567-241-3481
Mailing Address - Fax:
Practice Address - Street 1:1159 WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1940
Practice Address - Country:US
Practice Address - Phone:567-203-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.06190224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant