Provider Demographics
NPI:1053659433
Name:FENLON, ANGELA M (CTRS, ATRIC, CMS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:FENLON
Suffix:
Gender:F
Credentials:CTRS, ATRIC, CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10593 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-6847
Mailing Address - Country:US
Mailing Address - Phone:616-510-1128
Mailing Address - Fax:855-207-3270
Practice Address - Street 1:10593 NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-6847
Practice Address - Country:US
Practice Address - Phone:616-510-1128
Practice Address - Fax:855-207-3270
Is Sole Proprietor?:No
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist