Provider Demographics
NPI:1144290040
Name:HARDER, ANGELA DENISE (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENISE
Last Name:HARDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:DENISE
Other - Last Name:CRUISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:6378 TIMBER CLIMB DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9473
Mailing Address - Country:US
Mailing Address - Phone:317-223-8467
Mailing Address - Fax:
Practice Address - Street 1:6378 TIMBER CLIMB DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9473
Practice Address - Country:US
Practice Address - Phone:317-223-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000862A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant