Healthcare Provider Details

I. General information

NPI: 1396071783
Provider Name (Legal Business Name): ANGELA HARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35249 KENAI SPUR HWY UNIT C
SOLDOTNA AK
99669-7673
US

IV. Provider business mailing address

35249 KENAI SPUR HWY UNIT C
SOLDOTNA AK
99669-7673
US

V. Phone/Fax

Practice location:
  • Phone: 74-200-8369
  • Fax:
Mailing address:
  • Phone: 907-420-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number179225
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: