Provider Demographics
NPI:1720467459
Name:GLEUE, BECKY
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:GLEUE
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 1:3801 JOHNSON MILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6364
Mailing Address - Country:US
Mailing Address - Phone:479-856-6400
Mailing Address - Fax:479-856-6623
Practice Address - Street 1:3801 JOHNSON MILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6364
Practice Address - Country:US
Practice Address - Phone:479-856-6400
Practice Address - Fax:479-856-6623
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A866224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROT-A866OtherOCCUPATIONAL THERAPY ASSISTANT LICENSE