Healthcare Provider Details

I. General information

NPI: 1154950368
Provider Name (Legal Business Name): DANIELLE LEE GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 RIBAUT RD STE 102
BEAUFORT SC
29902-5490
US

IV. Provider business mailing address

1076 RIBAUT RD STE 102
BEAUFORT SC
29902-5490
US

V. Phone/Fax

Practice location:
  • Phone: 843-525-0045
  • Fax:
Mailing address:
  • Phone: 843-379-0836
  • Fax: 855-966-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6927
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: