Provider Demographics
NPI:1821511353
Name:ANGEL-HUSK, STARLENE A (LMT)
Entity Type:Individual
Prefix:
First Name:STARLENE
Middle Name:A
Last Name:ANGEL-HUSK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 RICHMOND RD.
Mailing Address - Street 2:#100
Mailing Address - City:WARRENSVILLE HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-378-9390
Mailing Address - Fax:216-378-1735
Practice Address - Street 1:26250 EUCLID AVE.
Practice Address - Street 2:#711
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-261-7715
Practice Address - Fax:216-261-7746
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.021888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist