Provider Demographics
NPI:1952558231
Name:GLENN, LAURIE MARIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:MARIA
Last Name:GLENN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6346 NE 61ST AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34488-1160
Mailing Address - Country:US
Mailing Address - Phone:352-812-4947
Mailing Address - Fax:352-512-0012
Practice Address - Street 1:6346 NE 61ST AVENUE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488-1160
Practice Address - Country:US
Practice Address - Phone:352-812-4947
Practice Address - Fax:352-512-0012
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-1442225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist