Healthcare Provider Details

I. General information

NPI: 1477618049
Provider Name (Legal Business Name): ANGELA FLYNN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

225 NELSON ST
PROVIDENCE RI
02908-2123
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5651
  • Fax:
Mailing address:
  • Phone: 401-861-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00796
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: