Provider Demographics
NPI:1578159398
Name:BRAUNREITER, ANGELA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BRAUNREITER
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 1:2917 E LESTER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3043
Mailing Address - Country:US
Mailing Address - Phone:520-971-8885
Mailing Address - Fax:
Practice Address - Street 1:1016 W UNIVERSITY AVE STE 222
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2997
Practice Address - Country:US
Practice Address - Phone:480-787-5387
Practice Address - Fax:866-473-0264
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-046828224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant