Provider Demographics
NPI:1255068565
Name:STEWART, GLENN PETER (OT)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:PETER
Last Name:STEWART
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-74 48TH AVE
Mailing Address - Street 2:APT 19L
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5615
Mailing Address - Country:US
Mailing Address - Phone:646-662-9184
Mailing Address - Fax:
Practice Address - Street 1:4-74 48TH AVE
Practice Address - Street 2:APT 19L
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5615
Practice Address - Country:US
Practice Address - Phone:646-662-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist