MEDICARE: HAYDEN GLENN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U1837449603	OTHER	NC	CIGNA

General Provider Information

NPI Number	:	1215521265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYDEN GLENN

Provider Business Mailing Address
First Line	:	3966 SUGARCREEK DR APT 418
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3966 SUGARCREEK DR APT 418
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3449
Country	:	US
Telephone Number	:	919-288-0322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2021
Last Update Date	:	02/08/2022

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Directions to “ HAYDEN GLENN ” Practice Location

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