Provider Demographics
NPI:1619211521
Name:MARZOLF, ANGELA NICOLE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:NICOLE
Last Name:MARZOLF
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 1:419 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2765
Mailing Address - Country:US
Mailing Address - Phone:706-664-8294
Mailing Address - Fax:
Practice Address - Street 1:5721 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853
Practice Address - Country:US
Practice Address - Phone:803-266-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2925224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant