Provider Demographics
NPI:1578114161
Name:SOPPE, ANGELICA KALEE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:KALEE
Last Name:SOPPE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-9721
Mailing Address - Country:US
Mailing Address - Phone:608-330-2909
Mailing Address - Fax:
Practice Address - Street 1:87 MANOR DR
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-9721
Practice Address - Country:US
Practice Address - Phone:608-330-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist