Provider Demographics
NPI:1538486121
Name:MARCEAU, ANGELA DAWN (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:MARCEAU
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 1:103 GOSSMAN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2225
Mailing Address - Country:US
Mailing Address - Phone:910-246-1158
Mailing Address - Fax:
Practice Address - Street 1:103 GOSSMAN RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2225
Practice Address - Country:US
Practice Address - Phone:910-246-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7231224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant