Healthcare Provider Details

I. General information

NPI: 1023928702
Provider Name (Legal Business Name): KELLYE GLASGOW LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 S 87TH ST
OMAHA NE
68124-3040
US

IV. Provider business mailing address

5824 CEDAR ST
OMAHA NE
68106-2238
US

V. Phone/Fax

Practice location:
  • Phone: 402-770-3298
  • Fax:
Mailing address:
  • Phone: 402-770-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2583
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: