Provider Demographics
NPI:1962223222
Name:GLISSON, RANDI MORGAN (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:MORGAN
Last Name:GLISSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:RANDI
Other - Middle Name:MORGAN
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:553 SAINT CHRISNIC CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9325
Mailing Address - Country:US
Mailing Address - Phone:980-396-8121
Mailing Address - Fax:
Practice Address - Street 1:1244 N FLINT ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-5239
Practice Address - Country:US
Practice Address - Phone:855-983-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist