Provider Demographics
NPI:1598095689
Name:DAVIDSON, ANGELA DENISE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DENISE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5584 SUNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-9449
Mailing Address - Country:US
Mailing Address - Phone:970-216-8135
Mailing Address - Fax:
Practice Address - Street 1:5584 SUNRIDGE DR
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-9449
Practice Address - Country:US
Practice Address - Phone:970-216-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist