Provider Demographics
NPI:1902070352
Name:SALLERSON, ANGELA B (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:SALLERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:B
Other - Last Name:HRABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:161 S. WAKEA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732
Mailing Address - Country:US
Mailing Address - Phone:808-244-7467
Mailing Address - Fax:808-242-4762
Practice Address - Street 1:161 S. WAKEA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:808-244-7467
Practice Address - Fax:808-242-4762
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI225X00000X
HI661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist