MEDICARE: MS. ANGELA KATHLEEN O'TOOLE DPT

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	225100000X	Physical Therapist	5501012733	MI

General Provider Information

NPI Number	:	1659331023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA KATHLEEN O'TOOLE DPT

Provider Business Mailing Address
First Line	:	2936 CASTOR RD
Second Line	:
City	:	WALES
State	:	MI
Zip	:	48027-1505
Country	:	US
Telephone Number	:	810-531-5298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 STONE ST
Second Line	:	STE 8
City	:	PORT HURON
State	:	MI
Zip	:	48060-3563
Country	:	US
Telephone Number	:	810-989-0000
Fax Number	:	810-989-5266

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	10/23/2013

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