Provider Demographics
NPI:1932344298
Name:CHARTRAND, GLENYS ANNE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:GLENYS
Middle Name:ANNE
Last Name:CHARTRAND
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 1:2419 N SANDSTONE PL
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6268
Mailing Address - Country:US
Mailing Address - Phone:719-251-4055
Mailing Address - Fax:
Practice Address - Street 1:2419 N SANDSTONE PL
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122
Practice Address - Country:US
Practice Address - Phone:719-251-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4994225XM0800X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA101511OtherPTAN