Provider Demographics
NPI:1891909834
Name:ARMSTRONG, GLENN (COTA)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W CLAIBORNE AVE
Mailing Address - Street 2:GREENWOOD, MS
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2753
Mailing Address - Country:US
Mailing Address - Phone:662-455-5588
Mailing Address - Fax:
Practice Address - Street 1:1600 W CLAIBORNE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2753
Practice Address - Country:US
Practice Address - Phone:662-455-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA1170224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant