Provider Demographics
NPI:1629236211
Name:MEYLOR OMAILIA, ANGELA MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:MEYLOR OMAILIA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NORTH WATER ST
Mailing Address - Street 2:HEARTLAND HEATH CARE
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818
Mailing Address - Country:US
Mailing Address - Phone:608-348-2453
Mailing Address - Fax:608-348-2944
Practice Address - Street 1:1300 NORTH WATER ST
Practice Address - Street 2:HEARTLAND HEATH CARE
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-348-2453
Practice Address - Fax:608-348-2944
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1566027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant