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General NPI Number Information
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NPI Number | 1477041580
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Entity Type | Individual
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Provider Name | IMANI NICOLE GLENN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 1575 E WASHINGTON BLVD
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City | PASADENA
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State | CA
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Zip | 91104-2675
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Country | US
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Telephone | 626-768-7764
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Fax |
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Provider Business Mailing Address
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Address Line | 20219 HARLAN AVE
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City | CARSON
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State | CA
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Zip | 90746-2549
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Country | US
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Telephone | 310-597-5846
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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