Healthcare Provider Details

I. General information

NPI: 1144149758
Provider Name (Legal Business Name): ANGELINA CASTLE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N WOLF RD
NORTHLAKE IL
60164-1670
US

IV. Provider business mailing address

8477 S SUNCOAST BLVD
HOMOSASSA FL
34446-5028
US

V. Phone/Fax

Practice location:
  • Phone: 800-381-0822
  • Fax:
Mailing address:
  • Phone: 800-381-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.027098
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: