Provider Demographics
NPI:1386101475
Name:GLASS-HINDS, LAURIE MICHELLE (OT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:MICHELLE
Last Name:GLASS-HINDS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:MICHELLE
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0009
Mailing Address - Country:US
Mailing Address - Phone:678-249-7120
Mailing Address - Fax:678-894-4218
Practice Address - Street 1:2848 LENOX RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-6004
Practice Address - Country:US
Practice Address - Phone:678-249-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT001160OtherOT LICENSE