Provider Demographics
NPI:1760787493
Name:GLOVER, DEIDRA MICHELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:MICHELLE
Last Name:GLOVER
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 1:100 E DARBY LN APT 1B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4586
Mailing Address - Country:US
Mailing Address - Phone:803-968-1118
Mailing Address - Fax:
Practice Address - Street 1:100 E DARBY LN APT 1B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-4586
Practice Address - Country:US
Practice Address - Phone:803-968-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist