Provider Demographics
NPI:1740940352
Name:MORIN, ANGELICA LYNN (OTA/L)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LYNN
Last Name:MORIN
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:LYNN
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA/L
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:HARRELLS
Mailing Address - State:NC
Mailing Address - Zip Code:28444-0388
Mailing Address - Country:US
Mailing Address - Phone:910-523-7857
Mailing Address - Fax:
Practice Address - Street 1:44 HORSEPEN DR
Practice Address - Street 2:
Practice Address - City:HARRELLS
Practice Address - State:NC
Practice Address - Zip Code:28444-9013
Practice Address - Country:US
Practice Address - Phone:910-523-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8966224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant