MEDICARE: ANGELA WELLER OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	16465	CA

General Provider Information

NPI Number	:	1598502064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WELLER OT

Provider Business Mailing Address
First Line	:	167 CAMPBELL DR
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-5235
Country	:	US
Telephone Number	:	818-966-2711
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 CAMPBELL DR
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-5235
Country	:	US
Telephone Number	:	818-966-2711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/15/2024

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Directions to “ ANGELA WELLER OT” Practice Location

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