Healthcare Provider Details

I. General information

NPI: 1497387112
Provider Name (Legal Business Name): KATHERINE WALTON GLUSZEK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W ACADEMY ST
MC GRAW NY
13101-9424
US

IV. Provider business mailing address

119 ROOSEVELT AVE
SYRACUSE NY
13210-3138
US

V. Phone/Fax

Practice location:
  • Phone: 607-836-3650
  • Fax:
Mailing address:
  • Phone: 315-506-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number02423901
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: