Provider Demographics
NPI:1548540693
Name:ANGEL, ROSA ISELA (COTA)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:ISELA
Last Name:ANGEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1249
Mailing Address - Country:US
Mailing Address - Phone:260-804-0027
Mailing Address - Fax:
Practice Address - Street 1:810 OAK BLVD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1249
Practice Address - Country:US
Practice Address - Phone:260-804-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001788A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant