Provider Demographics
NPI:1376717470
Name:VASSER, ANGELA (OTR)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VASSER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 3RD ST W
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1553
Mailing Address - Country:US
Mailing Address - Phone:715-682-0633
Mailing Address - Fax:
Practice Address - Street 1:422 3RD ST W
Practice Address - Street 2:SUITE 135
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1553
Practice Address - Country:US
Practice Address - Phone:715-682-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4384-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40899800Medicaid