Provider Demographics
NPI:1043681059
Name:ANGELES, ADRIENNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:ANGELES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 BURNHAM DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7207
Mailing Address - Country:US
Mailing Address - Phone:925-348-5271
Mailing Address - Fax:
Practice Address - Street 1:1000 NUT TREE RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4100
Practice Address - Country:US
Practice Address - Phone:707-624-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist