Provider Demographics
NPI:1356633960
Name:MOROG, ANGELA KATHLEEN (OTR MASTERS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KATHLEEN
Last Name:MOROG
Suffix:
Gender:F
Credentials:OTR MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SHERBROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 SHERBROOKE AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4639
Practice Address - Country:US
Practice Address - Phone:716-626-5824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63-006212225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist