=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265690150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLENWOOD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2008
-----------------------------------------------------
Last Update Date | 10/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 GLENWOOD LN
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-969-2880
-----------------------------------------------------
Fax | 205-795-3390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 GLENWOOD LN
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-969-2880
-----------------------------------------------------
Fax | 205-795-3390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MIS MANAGER
-----------------------------------------------------
Name | MR. PETE MCCALLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-969-2880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 2731
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 2279
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------