Provider Demographics
NPI:1043198047
Name:CARPENTER, ANGELA (COTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 REDWOOD ST APT 25
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2280
Mailing Address - Country:US
Mailing Address - Phone:608-797-6263
Mailing Address - Fax:608-797-6263
Practice Address - Street 1:1600 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2838
Practice Address - Country:US
Practice Address - Phone:608-783-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7215-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant