Healthcare Provider Details

I. General information

NPI: 1609795582
Provider Name (Legal Business Name): LORI ANGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 KIMLOR LN
WILMINGTON OH
45177-9740
US

IV. Provider business mailing address

20 KIMLOR LN
WILMINGTON OH
45177-9740
US

V. Phone/Fax

Practice location:
  • Phone: 937-269-1278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: