Provider Demographics
NPI:1710928445
Name:FUGE, ANGELLA NICOLE (ATC/R)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:NICOLE
Last Name:FUGE
Suffix:
Gender:F
Credentials:ATC/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17994 SW CAMAS ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4696
Mailing Address - Country:US
Mailing Address - Phone:503-888-7874
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 48TH AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-4904
Practice Address - Country:US
Practice Address - Phone:503-681-4238
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-1002932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer