Provider Demographics
NPI:1922322031
Name:CARTER, ANGELA PRIDE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PRIDE
Last Name:CARTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 PATRIOT WAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4640
Mailing Address - Country:US
Mailing Address - Phone:757-865-7186
Mailing Address - Fax:
Practice Address - Street 1:307 PATRIOT WAY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4640
Practice Address - Country:US
Practice Address - Phone:757-865-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000270225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist