Provider Demographics
NPI:1831459981
Name:FRITZ, ANGELA DENISE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:DENISE
Last Name:FRITZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E LAKE SHORE DR APT 34
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-1550
Mailing Address - Country:US
Mailing Address - Phone:423-240-6505
Mailing Address - Fax:
Practice Address - Street 1:21 E LAKE SHORE DR APT 34
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-1550
Practice Address - Country:US
Practice Address - Phone:423-240-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03889224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03889OtherCOTA/L