Provider Demographics
NPI:1598896169
Name:GLASS, JUDITH MARY (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MARY
Last Name:GLASS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-9673
Mailing Address - Country:US
Mailing Address - Phone:610-495-7486
Mailing Address - Fax:
Practice Address - Street 1:31 ELEANOR DR
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-9673
Practice Address - Country:US
Practice Address - Phone:610-495-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006907L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics