Provider Demographics
NPI:1710160874
Name:DAVIDSON, ANGELA LINETTE (BA ITFS BK)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LINETTE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:BA ITFS BK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 BLAINEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9409
Mailing Address - Country:US
Mailing Address - Phone:919-557-5653
Mailing Address - Fax:
Practice Address - Street 1:2008 BLAINEWOOD CT
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-9409
Practice Address - Country:US
Practice Address - Phone:919-557-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist