Provider Demographics
NPI:1255984480
Name:NONDORF, ANGELA MARIE (OTR)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:NONDORF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28510 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-5615
Mailing Address - Country:US
Mailing Address - Phone:269-423-2703
Mailing Address - Fax:
Practice Address - Street 1:23332 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9703
Practice Address - Country:US
Practice Address - Phone:269-283-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist