Provider Demographics
NPI:1508369455
Name:VALLIERE, ANGELA MARIE (OTRL, CHT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:VALLIERE
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 E MICHIGAN AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1854
Mailing Address - Country:US
Mailing Address - Phone:517-205-3897
Mailing Address - Fax:517-817-7634
Practice Address - Street 1:1201 E MICHIGAN AVE STE 320
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1854
Practice Address - Country:US
Practice Address - Phone:517-205-3897
Practice Address - Fax:517-205-7634
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001150225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist