MEDICARE: MRS. ANGELA MARIE DANEL MOTRL

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	1273	OK

General Provider Information

NPI Number	:	1760692594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIE DANEL MOTRL

Provider Business Mailing Address
First Line	:	4150 W EVERGREEN DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-1112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 W EVERGREEN DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-1112
Country	:	US
Telephone Number	:	405-921-9980
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/28/2010

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