| NPI | 1235332214 |
|---|---|
| Former Name | LISA B GLEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ 3619) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 5201006730) |
| 225X00000X Occupational Therapist (Licence: FL 3633) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2010-02-24 |