Provider Demographics
NPI:1467736280
Name:STRIEFF, ANGELA MARIE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:STRIEFF
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:LABUDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:28601 IMPERIAL DR APT B193
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4250
Mailing Address - Country:US
Mailing Address - Phone:313-832-1100
Mailing Address - Fax:
Practice Address - Street 1:5447 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-4009
Practice Address - Country:US
Practice Address - Phone:313-832-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1730116682174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730116682Medicaid
MI1730116682Medicaid