Individual
MRS. ANGELA TISE SAMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
187 VANCOUVER CT, KERNERSVILLE, NC 27284-9256
(336) 996-4744
(336) 996-4745
Mailing address
187 VANCOUVER CT, KERNERSVILLE, NC 27284-9256
(336) 996-4744
(336) 996-4745
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3990
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1217F
BCBS
NC
05
—
7301309
—
NC
01
—
D0591
MEDCOST
NC
Enumeration date
11/16/2007
Last updated
08/18/2008
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