Provider Demographics
NPI:1831829753
Name:GLASHEEN, CARSON (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:GLASHEEN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14200 SOMERSET PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1285
Mailing Address - Country:US
Mailing Address - Phone:954-790-4858
Mailing Address - Fax:
Practice Address - Street 1:3100 CORAL HILLS DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4137
Practice Address - Country:US
Practice Address - Phone:954-344-3180
Practice Address - Fax:954-344-3183
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist