Provider Demographics
NPI:1902109630
Name:GLAZE, ALLISON HEATHER (MS, OTR/L, LMT)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:HEATHER
Last Name:GLAZE
Suffix:
Gender:F
Credentials:MS, OTR/L, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 SW 63RD CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3328
Mailing Address - Country:US
Mailing Address - Phone:407-256-0795
Mailing Address - Fax:
Practice Address - Street 1:92410 OVERSEAS HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2636
Practice Address - Country:US
Practice Address - Phone:305-852-8600
Practice Address - Fax:305-852-8300
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist