Provider Demographics
NPI:1669934071
Name:THOMAS, ANGEL LEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:LEE
Other - Last Name:PETRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:408 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-1235
Mailing Address - Country:US
Mailing Address - Phone:724-600-6371
Mailing Address - Fax:
Practice Address - Street 1:401 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4131
Practice Address - Country:US
Practice Address - Phone:724-600-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009190225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist