Provider Demographics
NPI:1558852426
Name:HARRIS, ANGELA P (OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:P
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 JOY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-1305
Mailing Address - Country:US
Mailing Address - Phone:276-601-2838
Mailing Address - Fax:276-601-2839
Practice Address - Street 1:813 JOY RANCH RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-1305
Practice Address - Country:US
Practice Address - Phone:276-233-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002922225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist