Provider Demographics
NPI:1750045605
Name:MARSHBURN, ANGELA GRACE (COTA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:GRACE
Last Name:MARSHBURN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:97 HUGHES RD STE H
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3401
Mailing Address - Country:US
Mailing Address - Phone:256-883-7338
Mailing Address - Fax:256-883-7135
Practice Address - Street 1:97 HUGHES RD STE H
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3401
Practice Address - Country:US
Practice Address - Phone:256-883-7338
Practice Address - Fax:256-883-7135
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5705224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant