Provider Demographics
NPI:1902638950
Name:GLASS, ELIZABETH (OTD, OTR)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-2209
Mailing Address - Country:US
Mailing Address - Phone:623-478-5600
Mailing Address - Fax:
Practice Address - Street 1:1700 S 103RD AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-3000
Practice Address - Country:US
Practice Address - Phone:623-478-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist