Healthcare Provider Details

I. General information

NPI: 1972296598
Provider Name (Legal Business Name): ANGELICA TOKARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 E MICHIGAN BLVD
MICHIGAN CITY IN
46360-3189
US

IV. Provider business mailing address

711 OLIVE HILL DR
VALPARAISO IN
46383-4062
US

V. Phone/Fax

Practice location:
  • Phone: 219-247-7455
  • Fax:
Mailing address:
  • Phone: 708-928-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31007659A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: