Provider Demographics
NPI:1356031025
Name:DILLARD, ANGELA MARIE (RRT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:DILLARD
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RANDOLPH
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:102 W COURT SQ
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1882
Mailing Address - Country:US
Mailing Address - Phone:931-357-1379
Mailing Address - Fax:
Practice Address - Street 1:102 W COURT SQ
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1882
Practice Address - Country:US
Practice Address - Phone:931-357-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4432227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered