Provider Demographics
NPI:1730301300
Name:MCCABE, ANGELA ANN (OTRL)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANN
Last Name:MCCABE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LEWIS STREET
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252
Mailing Address - Country:US
Mailing Address - Phone:570-668-1643
Mailing Address - Fax:
Practice Address - Street 1:2200 1ST AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2065
Practice Address - Country:US
Practice Address - Phone:570-628-6950
Practice Address - Fax:570-628-4874
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005937L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist