MEDICARE: MRS. KATHERINE WALTON GLUSZEK 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	02423901	NY

General Provider Information

NPI Number	:	1497387112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE WALTON GLUSZEK OTR/L

Provider Business Mailing Address
First Line	:	119 ROOSEVELT AVE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-3138
Country	:	US
Telephone Number	:	315-506-5080
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 W ACADEMY ST
Second Line	:
City	:	MC GRAW
State	:	NY
Zip	:	13101-9424
Country	:	US
Telephone Number	:	607-836-3650
Fax Number	:

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

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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