MEDICARE: MS. ANGELA MAHONEY KREIDL MS OTRL

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	21415	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851419246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA MAHONEY KREIDL MS OTRL

Provider Business Mailing Address
First Line	:	1856 TIERRA VERDE DR
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-4527
Country	:	US
Telephone Number	:	508-241-4547
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 16TH AVE N STE B
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4819
Country	:	US
Telephone Number	:	904-249-8893
Fax Number	:	904-879-5707

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	06/17/2021

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