Individual
GLEN EUGENE RODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
8606 196TH ST CT E, SPANAWAY, WA 98387
(360) 888-3439
Mailing address
8606 196TH ST CT E, SPANAWAY, WA 98387
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC00001065
WA
Other
Enumeration date
02/15/2008
Last updated
02/15/2008
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