Provider Demographics
NPI:1407243819
Name:VILLALOBOS, ANGEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:VILLALOBOS
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 1:1297 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9411
Mailing Address - Country:US
Mailing Address - Phone:541-310-9558
Mailing Address - Fax:
Practice Address - Street 1:316 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1831
Practice Address - Country:US
Practice Address - Phone:541-310-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR458137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist