Healthcare Provider Details

I. General information

NPI: 1851255384
Provider Name (Legal Business Name): TERESA L GLOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD
PICKERINGTON OH
43147-8235
US

IV. Provider business mailing address

1119 YOUNG ST
MIDDLETOWN OH
45044-5824
US

V. Phone/Fax

Practice location:
  • Phone: 513-435-4723
  • Fax:
Mailing address:
  • Phone: 513-435-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1041C0700X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: