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General NPI Number Information
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NPI Number | 1780840645
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Entity Type | Individual
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Provider Name | ANGELLA DAWN POPINGA OTR/L, CLT-LANA
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Gender | Female
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 600 CELEBRATE LIFE PKWY
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City | NEWNAN
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State | GA
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Zip | 30265-8001
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Country | US
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Telephone | 770-400-6430
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Fax |
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Provider Business Mailing Address
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Address Line | 7 W VALLEY CT
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City | NEWNAN
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State | GA
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Zip | 30263-7452
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Country | US
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Telephone |
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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 | 456
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT005682
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License Number State | GA
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