Healthcare Provider Details

I. General information

NPI: 1013387703
Provider Name (Legal Business Name): TALITHA GLORIA GLOSEMEYER OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TALITHA GLORIA SCOTT OT/L

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 S JOPLIN AVE
TULSA OK
74136-2107
US

IV. Provider business mailing address

2400 W SHAWNEE ST
MUSKOGEE OK
74401-2275
US

V. Phone/Fax

Practice location:
  • Phone: 405-503-6825
  • Fax:
Mailing address:
  • Phone: 918-683-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT640
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT640
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License NumberOT640
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT640
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: