Provider Demographics
NPI:1164692885
Name:HAINES-GLAXNER, AMY I (CMT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:I
Last Name:HAINES-GLAXNER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100050 RALSTON ROAD
Mailing Address - Street 2:UNIT E
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004
Mailing Address - Country:US
Mailing Address - Phone:303-489-8480
Mailing Address - Fax:
Practice Address - Street 1:18339 W 60TH AVE
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1048
Practice Address - Country:US
Practice Address - Phone:303-489-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAOS06075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist