Provider Demographics
NPI:1477686723
Name:SMITH, ANGELA ANN (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:ANN
Other - Last Name:SIGMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR-L
Mailing Address - Street 1:4071 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4782
Mailing Address - Country:US
Mailing Address - Phone:828-448-1561
Mailing Address - Fax:
Practice Address - Street 1:1031 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5677
Practice Address - Country:US
Practice Address - Phone:828-757-6226
Practice Address - Fax:828-757-6289
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5638225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302004Medicaid