MEDICARE: MR. RICHARD W GLOVER 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	225X00000X	Occupational Therapist	OT003949	GA

General Provider Information

NPI Number	:	1467456012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD W GLOVER OTR/L

Provider Business Mailing Address
First Line	:	128 FRANCES MEEKS WAY STE 9
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3984
Country	:	US
Telephone Number	:	912-727-2321
Fax Number	:	912-445-0599

Provider Business Practice Location Address
First Line	:	128 FRANCES MEEKS WAY STE 9
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3984
Country	:	US
Telephone Number	:	912-727-2321
Fax Number	:	912-445-0599

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/03/2011

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