Healthcare Provider Details

I. General information

NPI: 1427009117
Provider Name (Legal Business Name): MARK DARREN HYLAND OTR/L, CHT, DABDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17233 N HOLMES BLVD SUITE 1650
PHOENIX AZ
85053-2018
US

IV. Provider business mailing address

17233 N HOLMES BLVD SUITE 1650
PHOENIX AZ
85053-2018
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-1836
  • Fax: 602-547-0809
Mailing address:
  • Phone: 602-467-8617
  • Fax: 602-547-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0461
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number0461
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0461
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number0461
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: