Healthcare Provider Details

I. General information

NPI: 1215296454
Provider Name (Legal Business Name): ANGELA GLORIA ROBERTS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W MAIN ST
UNION SC
29379-2641
US

IV. Provider business mailing address

1103 W MAIN ST
UNION SC
29379-2641
US

V. Phone/Fax

Practice location:
  • Phone: 828-962-3100
  • Fax:
Mailing address:
  • Phone: 828-962-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberOT.3545
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: