Basic Information
| Provider Information | |||||||||
| NPI: | 1336629187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANTRELL | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WHISPERING WINDS DR | ||||||||
| Address2: | |||||||||
| City: | GUNTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750582556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032678425 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1280 SETTLERS RDG | ||||||||
| Address2: | |||||||||
| City: | CELINA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750092282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723828600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2018 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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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 | 224Z00000X | 208849 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.