Healthcare Provider Details

I. General information

NPI: 1174779417
Provider Name (Legal Business Name): ANGELA MARIE SLAGLEY OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MEDICAL PARK DR SUITE 100
EFFINGHAM IL
62401-2191
US

IV. Provider business mailing address

901 MEDICAL PARK DR SUITE 100
EFFINGHAM IL
62401-2191
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-3003
  • Fax: 217-347-3005
Mailing address:
  • Phone: 217-347-3003
  • Fax: 217-347-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number056007361
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: