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NPI Code Detail

MEDICARE: ANGELA JAN INGRAM OTR, OTD

MEDICARE: ANGELA JAN INGRAM OTR, OTD
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
1225X00000XOccupational Therapist108519TX

General Provider Information

NPI Number : 1861515561
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA JAN INGRAM OTR, OTD
Provider Business Mailing Address
First Line : 1424 CAT MOUNTAIN TRL
Second Line :
City : KELLER
State : TX
Zip : 76248-3217
Country : US
Telephone Number : 214-797-2474
Fax Number :
Provider Business Practice Location Address
First Line : 350 KELLER PKWY
Second Line :
City : KELLER
State : TX
Zip : 76248-2249
Country : US
Telephone Number : 817-774-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 01/28/2025

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