Provider Demographics
NPI:1558605345
Name:GLENNON, JOHN EUGENE JR (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EUGENE
Last Name:GLENNON
Suffix:JR
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9122
Mailing Address - Country:US
Mailing Address - Phone:919-330-5309
Mailing Address - Fax:
Practice Address - Street 1:228 SMITH CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-1917
Practice Address - Country:US
Practice Address - Phone:919-658-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist