Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XM0800X | Mental Health | 4994 | AZ |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4994 | AZ |
NPI | 1932344298 |
---|---|
Provider Name | Mrs. Glenys Anne Chartrand |
First Address | Casa Grande, AZ 85122-6268 |
Second Address | Casa Grande, AZ 85122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 11/06/2019 |