Healthcare Provider Details

I. General information

NPI: 1598081937
Provider Name (Legal Business Name): GLENDA HUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BROOKWAY BLVD
BROOKHAVEN MS
39601-2637
US

IV. Provider business mailing address

631 BROOKWAY BLVD
BROOKHAVEN MS
39601-2637
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-7317
  • Fax: 601-835-0995
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1517
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: