Provider Demographics
NPI:1013904762
Name:COMSTOCK, ANGELA CECILE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CECILE
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:ADAMO
Other - Last Name:COMSTOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:1521 S HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1242
Mailing Address - Country:US
Mailing Address - Phone:417-540-2756
Mailing Address - Fax:877-423-3650
Practice Address - Street 1:1521 S HIGHVIEW AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1242
Practice Address - Country:US
Practice Address - Phone:417-540-2756
Practice Address - Fax:877-423-3650
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT 260225X00000X
MO002005225X00000X
KS17-02499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist