Provider Demographics
NPI:1861488371
Name:GLASOE, LEE S (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:S
Last Name:GLASOE
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1720 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2129
Practice Address - Country:US
Practice Address - Phone:605-334-5630
Practice Address - Fax:605-332-5327
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0063225X00000X
MN100335225X00000X
IA01344225X00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5830435Medicaid
SD5830436Medicaid
MN14G13GLOtherBLUE CROSS BLUE SHIELD MN
SD20141OtherSIOUX VALLEY HEALTH PLANS
SD64-05326OtherMEDICA
SD9G906GLOtherBLUE CROSS BLUE SHIELD MN
SD4994829OtherBLUE CROSS BLUE SHIELD SD
MN64-04223OtherMEDICA
SD24358OtherARAZ
SD4996802OtherBLUE CROSS BLUE SHIELD SD
MN64-03863OtherMEDICA
MN6434OtherAVERA HEALTH PLANS
SD64-07558OtherMEDICA
SD4996129OtherBLUE CROSS BLUE SHIELD SD
MN64-01488OtherMEDICA
SD4997070OtherBLUE CROSS BLUE SHEILD SD
SD5830433Medicaid
SD64-01485OtherMEDICA
MN64-03581OtherMEDICA
SD64-04204OtherMEDICA