Provider Demographics
NPI:1689936908
Name:MARSHALL, ANGELA KIM (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KIM
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N VALLEY PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3921
Mailing Address - Country:US
Mailing Address - Phone:972-353-5437
Mailing Address - Fax:
Practice Address - Street 1:401 N VALLEY PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3921
Practice Address - Country:US
Practice Address - Phone:972-353-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist