Provider Demographics
NPI:1851419246
Name:KREIDL, ANGELA MAHONEY (MS OTRL)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MAHONEY
Last Name:KREIDL
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DENISE
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTRL
Mailing Address - Street 1:1856 TIERRA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-4527
Mailing Address - Country:US
Mailing Address - Phone:508-241-4547
Mailing Address - Fax:
Practice Address - Street 1:340 16TH AVE N STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4819
Practice Address - Country:US
Practice Address - Phone:904-249-8893
Practice Address - Fax:904-879-5707
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21415225XP0200X
MA7964225X00000X
PAOC005976L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics