Provider Demographics
NPI:1396756169
Name:STROUP, ANGELA MARIE CONLEY (OT/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE CONLEY
Last Name:STROUP
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4491
Mailing Address - Country:US
Mailing Address - Phone:336-719-7129
Mailing Address - Fax:336-719-7396
Practice Address - Street 1:314 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4491
Practice Address - Country:US
Practice Address - Phone:336-719-7129
Practice Address - Fax:336-719-7396
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3915225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist