Provider Demographics
NPI:1497184733
Name:UNDERWOOD, ANGELA (STNA, LMT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:STNA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORTHLAND BLVD STE 103B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-0007
Mailing Address - Country:US
Mailing Address - Phone:513-400-7150
Mailing Address - Fax:
Practice Address - Street 1:230 NORTHLAND BLVD STE 103B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-0007
Practice Address - Country:US
Practice Address - Phone:513-400-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400794740808376K00000X
376K00000X, 372600000X, 374U00000X, 376J00000X
OH33.023467225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker