Healthcare Provider Details

I. General information

NPI: 1194580712
Provider Name (Legal Business Name): DAN GLENN HOTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 HAMILTON AVE
CINCINNATI OH
45231-2321
US

IV. Provider business mailing address

6838 BRAGG LN
HARRISON OH
45030-7514
US

V. Phone/Fax

Practice location:
  • Phone: 513-931-5000
  • Fax:
Mailing address:
  • Phone: 513-313-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberO1065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: