MEDICARE: MRS. ANGELA LOU SEAL MOT, OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	31004011A	IN

General Provider Information

NPI Number	:	1568708840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA LOU SEAL MOT, OTR

Provider Business Mailing Address
First Line	:	7375 W US 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-8950
Country	:	US
Telephone Number	:	888-877-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	7375 W US 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-8950
Country	:	US
Telephone Number	:	888-877-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2012
Last Update Date	:	06/19/2024

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