Healthcare Provider Details

I. General information

NPI: 1134896277
Provider Name (Legal Business Name): CAITILYN DYANE GLIDDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/15/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25925 BUDDE RD
SPRING TX
77380-2011
US

IV. Provider business mailing address

4606 FARM TO MARKET 1960 RD W STE 520
HOUSTON TX
77069
US

V. Phone/Fax

Practice location:
  • Phone: 281-465-4468
  • Fax:
Mailing address:
  • Phone: 346-333-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number218383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: