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NPI Code Detail

MEDICARE: ERIN GLIM OTR/L

MEDICARE: ERIN GLIM 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
1225X00000XOccupational Therapist056.011336IL

General Provider Information

NPI Number : 1467999300
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN GLIM OTR/L
Provider Business Mailing Address
First Line : 1005 W LARAWAY RD STE 230
Second Line :
City : NEW LENOX
State : IL
Zip : 60451-4117
Country : US
Telephone Number : 630-217-3590
Fax Number :
Provider Business Practice Location Address
First Line : 15127 S 73RD AVE STE C
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3463
Country : US
Telephone Number : 708-586-9303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2017
Last Update Date : 01/30/2017

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