Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0461 | AZ |
N | 2251E1200X | Ergonomics | 0461 | AZ |
N | 225XE1200X | Ergonomics | 0461 | AZ |
Y | 225XH1200X | Occupational Therapist - Hand | 0461 | AZ |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0461 | AZ |
NPI | 1427009117 |
---|---|
Provider Name | Mr. Mark Darren Hyland |
First Address | Phoenix, AZ 85053-2018 |
Second Address | Phoenix, AZ 85053-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
885527 | (05) | AZ |
S87007 | (02) | AZ |