Provider Demographics
NPI:1508331877
Name:WIGEN, ANGIE MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARIE
Last Name:WIGEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 11TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301
Mailing Address - Country:US
Mailing Address - Phone:712-363-1562
Mailing Address - Fax:
Practice Address - Street 1:1202 11 TH AVE SE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301
Practice Address - Country:US
Practice Address - Phone:712-363-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant