Provider Demographics
NPI:1952838013
Name:PHILIPPS, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PHILIPPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JACKSON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-1144
Mailing Address - Country:US
Mailing Address - Phone:937-726-8154
Mailing Address - Fax:
Practice Address - Street 1:512 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2718
Practice Address - Country:US
Practice Address - Phone:937-726-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-002390224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant