Provider Demographics
NPI:1528599800
Name:HAROLD, ANGELA DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:HAROLD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-0826
Mailing Address - Country:US
Mailing Address - Phone:681-220-9237
Mailing Address - Fax:
Practice Address - Street 1:2241 RITTER DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-2241
Practice Address - Country:US
Practice Address - Phone:304-731-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2014-3292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist