Individual provider Active NPI

Lynnae Glascock, MOTR/L

  • Occupational Therapist
  • Quincy, IL
National Provider Identifier
1346429917
Registry record updated Jun 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056-007305 Issued in IL
Practice address
1025 Maine St
Quincy, IL 62301-4038
Phone
(217) 222-6550
NPI assigned
Oct 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 056-007305 IL Primary

Addresses

Primary practice location

1025 Maine St
Quincy, IL 62301-4038

Mailing address

1025 Maine St
Quincy, IL 62301-4038
Phone (217) 222-6550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100526001065 IL Practitioner - Occupational Therapist in Private Practice 5890824007 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
056-007305ILMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Apr 19, 2010 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Apr 19, 2010 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC Current Accepting new patients

Locations

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276128000000",
    "number": "1346429917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASCOCK",
        "first_name": "LYNNAE",
        "credential": "MOTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-30",
        "last_updated": "2010-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056-007305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.