Provider Demographics
NPI:1821338005
Name:GLIESMAN, SUSAN (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GLIESMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15751 BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3567
Mailing Address - Country:US
Mailing Address - Phone:913-710-1851
Mailing Address - Fax:
Practice Address - Street 1:15751 BEVERLY ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3567
Practice Address - Country:US
Practice Address - Phone:913-710-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00647174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist