Healthcare Provider Details

I. General information

NPI: 1023102936
Provider Name (Legal Business Name): ANGELA LANGDON MILLS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 MANCHESTER SQUARE
MANCHESTER KY
40962-9998
US

IV. Provider business mailing address

46 FROG LEVEL RD
MANCHESTER KY
40962
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-7673
  • Fax: 606-598-7948
Mailing address:
  • Phone: 606-599-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKYR1768
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: