Provider Demographics
NPI:1184080566
Name:GLOWACKI, TAMMY L (OT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:GLOWACKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7858 SHRADER RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4222
Practice Address - Country:US
Practice Address - Phone:804-527-6835
Practice Address - Fax:804-273-9294
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0119002032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist