Provider Demographics
NPI:1679914873
Name:STAUBLE, ANGELA BARBARA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BARBARA
Last Name:STAUBLE
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 1:305 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1719
Mailing Address - Country:US
Mailing Address - Phone:617-244-8480
Mailing Address - Fax:617-244-8312
Practice Address - Street 1:305 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1719
Practice Address - Country:US
Practice Address - Phone:617-244-8480
Practice Address - Fax:617-244-8312
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10721225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist