Healthcare Provider Details

I. General information

NPI: 1669452579
Provider Name (Legal Business Name): GLENN JOSEPH GARGANO OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98 NAVAL HOSPITAL
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

3850 YESTEROAKS DR
PENSACOLA FL
32504-4321
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6394
  • Fax:
Mailing address:
  • Phone: 850-505-6727
  • Fax: 850-505-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 11038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: