Provider Demographics
NPI:1538334057
Name:ZUBELLA, ANGELA M (M, OTR)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:ZUBELLA
Suffix:
Gender:F
Credentials:M, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:ARPIN
Mailing Address - State:WI
Mailing Address - Zip Code:54410-9558
Mailing Address - Country:US
Mailing Address - Phone:715-652-2103
Mailing Address - Fax:715-652-2560
Practice Address - Street 1:1401 CHURCHILL ST.
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2027
Practice Address - Country:US
Practice Address - Phone:715-258-8131
Practice Address - Fax:715-258-0179
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1943-027224Z00000X
WI4907-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538334057Medicaid