Healthcare Provider Details

I. General information

NPI: 1972416006
Provider Name (Legal Business Name): KAITLIN REESE GLICINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 PARKWOOD DR
CHAMBERSBURG PA
17201-4501
US

IV. Provider business mailing address

3520 LINCOLN WAY E
FAYETTEVILLE PA
17222-1152
US

V. Phone/Fax

Practice location:
  • Phone: 717-446-0439
  • Fax:
Mailing address:
  • Phone: 720-934-9658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP010817
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: