Provider Demographics
NPI:1154761427
Name:AMADOR, ANGELIQUE MARIE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:ANGELIQUE
Middle Name:MARIE
Last Name:AMADOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N SAINT CLOUD ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5611
Mailing Address - Country:US
Mailing Address - Phone:610-570-9768
Mailing Address - Fax:
Practice Address - Street 1:390 RED SCHOOL LN
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2230
Practice Address - Country:US
Practice Address - Phone:908-859-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09078700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant