Provider Demographics
NPI:1619230257
Name:CRAFT, ANGELA RENAE
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:RENAE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SEMINOLE LN
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7864
Mailing Address - Country:US
Mailing Address - Phone:606-855-0375
Mailing Address - Fax:
Practice Address - Street 1:98 SEMINOLE LN
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7864
Practice Address - Country:US
Practice Address - Phone:606-855-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYXXX-XX-3378222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist