Provider Demographics
NPI:1134896277
Name:GLIDDEN, CAITILYN DYANE
Entity type:Individual
Prefix:
First Name:CAITILYN
Middle Name:DYANE
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 FARM TO MARKET 1960 RD W
Mailing Address - Street 2:STE 520
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069
Mailing Address - Country:US
Mailing Address - Phone:346-333-2794
Mailing Address - Fax:
Practice Address - Street 1:25925 BUDDE RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2011
Practice Address - Country:US
Practice Address - Phone:281-465-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218383224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty