Provider Demographics
NPI:1467768184
Name:HOMER, ANGELA M (MT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:HOMER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 K ST NW
Mailing Address - Street 2:SUITE C-120
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1831
Mailing Address - Country:US
Mailing Address - Phone:202-463-7611
Mailing Address - Fax:
Practice Address - Street 1:2175 K ST NW
Practice Address - Street 2:SUITE C-120
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1831
Practice Address - Country:US
Practice Address - Phone:202-463-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT0511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist