Provider Demographics
NPI:1609175439
Name:BLOOD, GLENDA LOIS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:LOIS
Last Name:BLOOD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 RIGHT FORK HAMILTON RDG
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-8724
Mailing Address - Country:US
Mailing Address - Phone:606-464-9132
Mailing Address - Fax:606-464-9133
Practice Address - Street 1:395 RIGHT FORK HAMILTON RDG
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-8724
Practice Address - Country:US
Practice Address - Phone:606-464-9132
Practice Address - Fax:606-464-9133
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYR1200OtherOCCUPATIONAL THERAPY LICENSE