MEDICARE: MR. MICHAEL JOHN GLANCY OTR/L

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	225XP0200X	Pediatric Occupational Therapist	011924-1	NY

General Provider Information

NPI Number	:	1417192246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOHN GLANCY OTR/L

Provider Business Mailing Address
First Line	:	2402 E 63RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6705
Country	:	US
Telephone Number	:	718-344-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 E 63RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6705
Country	:	US
Telephone Number	:	718-344-5137
Fax Number	:

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/08/2008

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