Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 013541-1 | NY |
Y | 225X00000X | Occupational Therapist | 46TR00416800 | NJ |
NPI | 1003076811 |
---|---|
Provider Name | Mr. Shaun Joseph Glover |
First Address | Norwood, NJ 07648-1555 |
Second Address | Norwood, NJ 07648-1555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 16/06/2008 |