Provider Demographics
NPI:1629376348
Name:GLAZER, JENNIFER HECK (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HECK
Last Name:GLAZER
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 1:105 S 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3805
Mailing Address - Country:US
Mailing Address - Phone:402-392-2802
Mailing Address - Fax:
Practice Address - Street 1:3226 S 112TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4708
Practice Address - Country:US
Practice Address - Phone:402-672-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE197225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91182814501Medicaid