Organization
ANGIE'S SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA MOUGEY (OWNER)
(419) 483-3793
Entity
Organization
Contact information
Practice address
855 W MAIN ST, SUITE D, BELLEVUE, OH 44811-9078
(419) 483-3793
(419) 483-5417
Mailing address
855 W MAIN ST, SUITE D, BELLEVUE, OH 44811-9078
(419) 483-3793
(419) 483-5417
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000340887
ANTHEM
OH
05
—
2471463
—
OH
Enumeration date
04/03/2006
Last updated
04/20/2008
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