Provider Demographics
NPI:1851345003
Name:PRUNER, GLENDA EULENE (OTR)
Entity Type:Individual
Prefix:MISS
First Name:GLENDA
Middle Name:EULENE
Last Name:PRUNER
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 1:970 LCR 324
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76678-1216
Mailing Address - Country:US
Mailing Address - Phone:254-344-2420
Mailing Address - Fax:254-344-2420
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-0240
Practice Address - Fax:254-743-0028
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist