Basic Information
| Provider Information | |||||||||
| NPI: | 1205169042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAPTIS | ||||||||
| FirstName: | GLENDA | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 40 | ||||||||
| Address2: | |||||||||
| City: | SALUDA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047585250 | ||||||||
| FaxNumber: | 8047585183 | ||||||||
| Practice Location | |||||||||
| Address1: | 5372B OLD VIRGINIA STREET | ||||||||
| Address2: | |||||||||
| City: | URBANNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575396300 | ||||||||
| FaxNumber: | 7575390704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2009 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119004484 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004979796 | 05 | VA | MEDICAID | 49-7813-7 | 05 | VA | MEDICAID |