Provider Demographics
NPI:1124398870
Name:WOOD, ANGELA KIM (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KIM
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 WALES AVE.
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3449
Mailing Address - Country:US
Mailing Address - Phone:419-733-2456
Mailing Address - Fax:
Practice Address - Street 1:3643 SHAWNEE ROAD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1539
Practice Address - Country:US
Practice Address - Phone:419-991-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019963225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist