Healthcare Provider Details

I. General information

NPI: 1417665787
Provider Name (Legal Business Name): OLIVIA B GLAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S COLLEGE ST
MARTINSBURG WV
25401-3307
US

IV. Provider business mailing address

109 S COLLEGE ST
MARTINSBURG WV
25401-3307
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3595
  • Fax: 304-267-3599
Mailing address:
  • Phone: 304-267-3595
  • Fax: 304-267-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2289
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: