Glenda Neighbors McConnell, OT/L
Individual provider Active NPI Occupational Therapist · Hazlehurst, MS
NPI 1053550806 · NPPES record last updated Apr 18, 2016
Key facts
- NPI
- 1053550806
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT1891 (MS)
- Practice address
- 247 Caldwell Dr
Hazlehurst, MS 39083-2711 - Phone
- (601) 894-3646
- NPI assigned
- Feb 18, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fitness Clinic Wellness
Practice addresses (Care Compare)
Madison, MS 39110
Phone (601) 983-7494
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210901001120 | MS | Practitioner - Occupational Therapist in Private Practice | 7214333137 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT1891 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fitness Clinic Wellness | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT1891 | MS | Yes |
Addresses
Primary practice location
247 Caldwell Dr
Hazlehurst, MS 39083-2711
Mailing address
100 Foxgate PL
Jackson, MS 39211-2202
Phone (601) 594-9272
Other providers in Hazlehurst, MS
- Mahesh Mehta MD PLLC
- Brenda J Martin
- Kayla Elise Massey
- Remonica Shanta McBride
- Lashisna McClendon
- Fred J McDonnell
- Preston McDonnell
- Elizabeth McKinley
- Medicomp, Inc
- Jason Dean Miles
All providers in Hazlehurst, MS · Occupational Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.