Provider Demographics
NPI:1659331023
Name:O'TOOLE, ANGELA KATHLEEN (DPT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KATHLEEN
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2936 CASTOR RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:MI
Mailing Address - Zip Code:48027-1505
Mailing Address - Country:US
Mailing Address - Phone:810-531-5298
Mailing Address - Fax:
Practice Address - Street 1:1201 STONE ST
Practice Address - Street 2:STE 8
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3563
Practice Address - Country:US
Practice Address - Phone:810-989-0000
Practice Address - Fax:810-989-5266
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist