Provider Demographics
NPI:1811056476
Name:GLASER-BLOCK, KATHLEEN MARY (OTR)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:GLASER-BLOCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 PUTNEY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-8857
Mailing Address - Country:US
Mailing Address - Phone:802-387-5794
Mailing Address - Fax:
Practice Address - Street 1:246 PUTNEY MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-8857
Practice Address - Country:US
Practice Address - Phone:802-387-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist