Provider Demographics
NPI:1861679896
Name:GLICK, LINDA O'TOOLE (CMT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:O'TOOLE
Last Name:GLICK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11106 DEL RIO DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5339
Mailing Address - Country:US
Mailing Address - Phone:703-591-1642
Mailing Address - Fax:
Practice Address - Street 1:11106 DEL RIO DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5339
Practice Address - Country:US
Practice Address - Phone:703-591-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist