Provider Demographics
NPI:1427009117
Name:HYLAND, MARK DARREN (OTR/L, CHT, DABDA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DARREN
Last Name:HYLAND
Suffix:
Gender:M
Credentials:OTR/L, CHT, DABDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17233 N HOLMES BLVD
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2018
Mailing Address - Country:US
Mailing Address - Phone:602-467-8617
Mailing Address - Fax:602-547-0508
Practice Address - Street 1:17233 N HOLMES BLVD
Practice Address - Street 2:SUITE 1650
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2018
Practice Address - Country:US
Practice Address - Phone:602-547-1836
Practice Address - Fax:602-547-0809
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0461225X00000X, 225XE1200X, 225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ885527Medicaid
AZ885527Medicaid
AZS87007Medicare UPIN