Healthcare Provider Details

I. General information

NPI: 1649180498
Provider Name (Legal Business Name): ANGELA RALEIGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 BURDETTE ST
FERNDALE MI
48220-1055
US

IV. Provider business mailing address

2610 PINECREST DR
FERNDALE MI
48220-2709
US

V. Phone/Fax

Practice location:
  • Phone: 248-586-8820
  • Fax:
Mailing address:
  • Phone: 586-945-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: