Individual
ELIZABETH ANN GLUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 HILLS AND DALES FARM RD, LAGRANGE, GA 30240-3805
(762) 323-1145
Mailing address
202 N VIEW POINTE DR, LAGRANGE, GA 30241-9194
(706) 302-7105
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4500
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4500
GA LICENSE
GA
Enumeration date
02/13/2023
Last updated
02/13/2023
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