Provider Demographics
NPI:1922487735
Name:GLEBA, JACEE (OT)
Entity Type:Individual
Prefix:
First Name:JACEE
Middle Name:
Last Name:GLEBA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 RODANTHE CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8695
Mailing Address - Country:US
Mailing Address - Phone:785-534-3704
Mailing Address - Fax:
Practice Address - Street 1:1800 2ND LOOP RD STE 8
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6180
Practice Address - Country:US
Practice Address - Phone:843-407-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist