Provider Demographics
NPI:1952000648
Name:GLADE, MELISSA (COTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GLADE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 KNIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-1204
Mailing Address - Country:US
Mailing Address - Phone:505-980-2166
Mailing Address - Fax:
Practice Address - Street 1:5004 KNIGHTS CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-1204
Practice Address - Country:US
Practice Address - Phone:505-980-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist