Provider Demographics
NPI:1255713681
Name:MURSENER-GONZALES, ANGELA JOHNSON (MOT, OTR)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JOHNSON
Last Name:MURSENER-GONZALES
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S 500 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3357
Mailing Address - Country:US
Mailing Address - Phone:801-692-6830
Mailing Address - Fax:
Practice Address - Street 1:915 S 500 E
Practice Address - Street 2:SUITE 101
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3357
Practice Address - Country:US
Practice Address - Phone:801-692-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist