Provider Demographics
NPI:1720339880
Name:WELLS, ANGELA RENA
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RENA
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 NE 14TH STREET,SUITE 5
Mailing Address - Street 2:BUTTERFLY EFFECTS
Mailing Address - City:POMPANA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:888-880-9270
Mailing Address - Fax:
Practice Address - Street 1:2708 NE 14TH STREET,SUITE 5
Practice Address - Street 2:BUTTERFLY EFFECTS
Practice Address - City:POMPANA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist