Provider Demographics
NPI:1730805383
Name:HANDLEY, GLEN ANDREW (OT0007619)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:ANDREW
Last Name:HANDLEY
Suffix:
Gender:M
Credentials:OT0007619
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 W ANTELOPE DR APT D
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-1123
Mailing Address - Country:US
Mailing Address - Phone:502-595-7903
Mailing Address - Fax:
Practice Address - Street 1:4302 W ANTELOPE DR APT D
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-1123
Practice Address - Country:US
Practice Address - Phone:502-595-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist