Provider Demographics
NPI:1629659222
Name:GLOVER, TANISHA NICOLE (LRT, CTRS)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:NICOLE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LRT, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 S BALL ST APT 530
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4444
Mailing Address - Country:US
Mailing Address - Phone:919-438-8934
Mailing Address - Fax:
Practice Address - Street 1:601 PERRYVILLE DR
Practice Address - Street 2:
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902-1111
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist