Provider Demographics
NPI:1568936375
Name:ANGLEBERGER, MELISSA (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ANGLEBERGER
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 1:9229 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21798-8817
Mailing Address - Country:US
Mailing Address - Phone:301-639-4012
Mailing Address - Fax:
Practice Address - Street 1:1920 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8249
Practice Address - Country:US
Practice Address - Phone:240-772-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02315224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant