MEDICARE: MR. GLENN PETER STEWART OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	007248	NY

General Provider Information

NPI Number	:	1255068565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLENN PETER STEWART OT

Provider Business Mailing Address
First Line	:	4-74 48TH AVE
Second Line	:	APT 19L
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5615
Country	:	US
Telephone Number	:	646-662-9184
Fax Number	:

Provider Business Practice Location Address
First Line	:	4-74 48TH AVE
Second Line	:	APT 19L
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5615
Country	:	US
Telephone Number	:	646-662-9184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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