Provider Demographics
NPI:1063237923
Name:FAILLA, ANGELINA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:FAILLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2389
Mailing Address - Country:US
Mailing Address - Phone:860-483-2939
Mailing Address - Fax:
Practice Address - Street 1:350 CENTER ROCK GREEN STE. 10
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478
Practice Address - Country:US
Practice Address - Phone:203-828-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist