Provider Demographics
NPI:1992386783
Name:DIRKERS, ANGELA KATHRYN (LMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KATHRYN
Last Name:DIRKERS
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:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:STRATTON
Mailing Address - State:ME
Mailing Address - Zip Code:04982-0216
Mailing Address - Country:US
Mailing Address - Phone:435-602-3077
Mailing Address - Fax:
Practice Address - Street 1:241 BLACK POINT RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9356
Practice Address - Country:US
Practice Address - Phone:435-602-3077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6847225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist