Provider Demographics
NPI:1306619333
Name:GLAZIER, CASEY (COTA/L)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GLAZIER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 E COVEY LN
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6226
Mailing Address - Country:US
Mailing Address - Phone:605-661-7811
Mailing Address - Fax:
Practice Address - Street 1:507 N SPRING STREET
Practice Address - Street 2:
Practice Address - City:AVE
Practice Address - State:MO
Practice Address - Zip Code:65608-6560
Practice Address - Country:US
Practice Address - Phone:605-661-7811
Practice Address - Fax:417-683-5450
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028204224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant