Individual
AMANDA DEANGELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DROT
Contact information
Practice address
800 MEDCALF STREET, MONTESANO, WA 98563
(360) 249-2273
Mailing address
1105 VESTAL RD, VESTAL, NY 13850-1719
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
18087
CA
225X00000X
Occupational Therapist
Primary
OT60855194
WA
Other
Enumeration date
04/03/2018
Last updated
07/25/2018
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