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General NPI Number Information
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NPI Number | 1790157436
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Entity Type | Individual
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Provider Name | ANGELA M PENCE OTA
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Gender | Female
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1333 N 1ST ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477
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Country | US
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Telephone | 541-736-2732
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Fax |
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Provider Business Mailing Address
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Address Line | 38927 W SCIO RD
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City | SCIO
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State | OR
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Zip | 97374-9587
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Country | US
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Telephone | 504-480-5879
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 348216
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License Number State | OR
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