Provider Demographics
NPI:1861973653
Name:HOUSE, ANGIE RAE (COTA)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:RAE
Last Name:HOUSE
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 1:248 RINACA LN
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:VA
Mailing Address - Zip Code:22849-3655
Mailing Address - Country:US
Mailing Address - Phone:717-404-0057
Mailing Address - Fax:
Practice Address - Street 1:30 MONTVUE DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1057
Practice Address - Country:US
Practice Address - Phone:540-743-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant