MEDICARE: MRS. JILL J. GLINKA OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	17-00109	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013420	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306879770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL J. GLINKA OTR/L

Provider Business Mailing Address
First Line	:	5316 SW LINCOLNSHIRE CIR
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66610-9662
Country	:	US
Telephone Number	:	785-862-9222
Fax Number	:	785-862-8807

Provider Business Practice Location Address
First Line	:	5316 SW LINCOLNSHIRE CIR
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66610-9662
Country	:	US
Telephone Number	:	785-862-9222
Fax Number	:	785-862-8807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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