Healthcare Provider Details

I. General information

NPI: 1639368533
Provider Name (Legal Business Name): FLORIE GLUSMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 BRIARWOOD INDUSTRIAL CT NE STE A
BROOKHAVEN GA
30329-1642
US

IV. Provider business mailing address

1816 BRIARWOOD INDUSTRIAL CT NE STE A
BROOKHAVEN GA
30329-1642
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-5272
  • Fax: 404-636-5644
Mailing address:
  • Phone: 404-636-5272
  • Fax: 404-636-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2642
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: