Individual
JAMIE LEE GLAZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
290 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1560
(770) 460-0165
Mailing address
290 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1560
(770) 460-0165
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005309
GA
Other
Enumeration date
09/20/2011
Last updated
07/18/2014
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