Provider Demographics
NPI:1356441166
Name:COLEMAN, GLENDA KAY (OTR)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:KAY
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:GLENDA
Other - Middle Name:C
Other - Last Name:LOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:329 COUNTY ROAD 392
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-530-7555
Mailing Address - Fax:
Practice Address - Street 1:329 COUNTY ROAD 392
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-530-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR340225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T749OtherBLUE CROSS BLUE SHIELD
AR116283721Medicaid