Provider Demographics
NPI:1164848990
Name:KEEZER, ANGELA (COTAL)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KEEZER
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1555 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1555 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9775
Practice Address - Country:US
Practice Address - Phone:989-723-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant