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General NPI Number Information
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NPI Number | 1407736010
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Entity Type | Individual
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Provider Name | GLENN CARPENTER
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Gender | Male
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 130 OAKDALE AVE
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City | TOLEDO
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State | OH
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Zip | 43605-3323
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Country | US
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Telephone | 419-478-1542
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 398
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City | TOLEDO
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State | OH
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Zip | 43697-0398
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Country | US
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Telephone | 419-367-6834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | HRC-18-00004
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | HRC-18-00004
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License Number State | OH
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