Provider Demographics
NPI:1235274937
Name:BOX, ANGELA MARIE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:BOX
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:GOECKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:3504 HIGHWAY 153 # 334
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-7553
Mailing Address - Country:US
Mailing Address - Phone:662-816-9817
Mailing Address - Fax:
Practice Address - Street 1:400 PEARMAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-3100
Practice Address - Country:US
Practice Address - Phone:864-260-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5525225X00000X
MO2005028244225XP0200X
IL056008219225XP0200X
AZ4150225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO477584809Medicaid
AZ355290Medicaid