Provider Demographics
NPI:1407130032
Name:GARLICK, ANGELA NELDA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NELDA
Last Name:GARLICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3129
Mailing Address - Country:US
Mailing Address - Phone:607-437-2903
Mailing Address - Fax:
Practice Address - Street 1:2020 JUMP BROOK ROAD
Practice Address - Street 2:
Practice Address - City:GRAND GORGE
Practice Address - State:NY
Practice Address - Zip Code:12434
Practice Address - Country:US
Practice Address - Phone:607-588-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013115-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist