Provider Demographics
NPI:1003114190
Name:RIZO ROSALES, ANGELA (MA OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:RIZO ROSALES
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4306
Mailing Address - Country:US
Mailing Address - Phone:612-789-1236
Mailing Address - Fax:176-074-9998
Practice Address - Street 1:1033 CHRISTENSEN AVE.
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3075
Practice Address - Country:US
Practice Address - Phone:651-216-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103684225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103684OtherHEALTH OCCUPATIONS PROGRAM MINNESOTA DEPARTMENT OF HEALTH
268870OtherTHE NATIONAL BOARD FOR CERTIFICATION IN OCCPATIONAL THERAPY, INC.