Provider Demographics
NPI:1013329986
Name:ETTER, ANGELA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ETTER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:NEW RIEGEL
Mailing Address - State:OH
Mailing Address - Zip Code:44853-9618
Mailing Address - Country:US
Mailing Address - Phone:419-944-9471
Mailing Address - Fax:
Practice Address - Street 1:1000 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-9614
Practice Address - Country:US
Practice Address - Phone:419-435-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.008094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist