Provider Demographics
NPI:1689808321
Name:CONNELL, ANGELA HAMMOND (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:HAMMOND
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 RHYNE CHASE SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4246
Mailing Address - Country:US
Mailing Address - Phone:205-454-2794
Mailing Address - Fax:
Practice Address - Street 1:4286 BELLS FERRY RD NW STE 210
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1302
Practice Address - Country:US
Practice Address - Phone:678-401-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-10
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004768225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist