Provider Demographics
NPI:1093270621
Name:CREGER, ANGELIQUE ANN (OT)
Entity Type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:ANN
Last Name:CREGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:ANN
Other - Last Name:CREGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 FLINTWOOD ST SW
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7449
Mailing Address - Country:US
Mailing Address - Phone:612-810-0729
Mailing Address - Fax:
Practice Address - Street 1:701 DELLWOOD ST S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1920
Practice Address - Country:US
Practice Address - Phone:612-262-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5699225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist