Healthcare Provider Details

I. General information

NPI: 1457280745
Provider Name (Legal Business Name): ELISSA GLIBBERY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FREESTONE RD
EAGLE CO
81631-5930
US

IV. Provider business mailing address

PO BOX 4225
GYPSUM CO
81637-4225
US

V. Phone/Fax

Practice location:
  • Phone: 970-423-1123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: