Provider Demographics
NPI:1871865964
Name:GLOETZNER, RYAN EDGAR (MOTR/L)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:EDGAR
Last Name:GLOETZNER
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9501
Mailing Address - Country:US
Mailing Address - Phone:505-615-4557
Mailing Address - Fax:
Practice Address - Street 1:5620 CLOVER PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-6711
Practice Address - Country:US
Practice Address - Phone:505-615-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017116225X00000X
OHOT009151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist