Provider Demographics
NPI:1730307265
Name:OLIVER, ANGELA BETH (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:BETH
Last Name:OLIVER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:BETH
Other - Last Name:ENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2420 CONLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3464
Mailing Address - Country:US
Mailing Address - Phone:989-233-0206
Mailing Address - Fax:
Practice Address - Street 1:3525 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3308
Practice Address - Country:US
Practice Address - Phone:989-497-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer