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General NPI Number Information
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NPI Number | 1093270621
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Entity Type | Individual
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Provider Name | ANGELIQUE ANN CREGER OT
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Gender | Female
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 701 DELLWOOD ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1920
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Country | US
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Telephone | 612-262-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 310 FLINTWOOD ST SW
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City | ISANTI
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State | MN
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Zip | 55040-7449
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Country | US
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Telephone | 612-810-0729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5699
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License Number State | MN
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