Provider Demographics
NPI:1639874043
Name:GLOVER, JUANITA (OTA/L)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 WOODWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1187
Mailing Address - Country:US
Mailing Address - Phone:216-255-2764
Mailing Address - Fax:444-405-3830
Practice Address - Street 1:3902 WOODWORTH DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1187
Practice Address - Country:US
Practice Address - Phone:212-162-5527
Practice Address - Fax:440-538-3006
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant