Individual
MR. MICHAEL SCOTT GLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
242 MOUNTAIN RD, GRANTS, NM 87020-2602
(505) 876-6030
(505) 876-6151
Mailing address
7309 QUARTZITE AVE NW, ALBUQUERQUE, NM 87114-3541
(505) 890-8767
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1599
NM
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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