Provider Demographics
NPI:1720414436
Name:ROBERTS, ANGEL (COTA)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 ATLASRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77048-5575
Mailing Address - Country:US
Mailing Address - Phone:832-665-5486
Mailing Address - Fax:
Practice Address - Street 1:6415 ATLASRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048-5575
Practice Address - Country:US
Practice Address - Phone:832-665-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210666224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant