Basic Information
| Provider Information | |||||||||
| NPI: | 1174779417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLAGLEY | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 MEDICAL PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173473003 | ||||||||
| FaxNumber: | 2173473005 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 MEDICAL PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173473003 | ||||||||
| FaxNumber: | 2173473005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 06/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 056007361 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 371386095 | 01 | HEALTHLINK | OTHER | 2500075 | 01 | IL | BCBS | OTHER |