Provider Demographics
NPI:1194212209
Name:CUSTER, ANGELA (OTR)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25018 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2722
Mailing Address - Country:US
Mailing Address - Phone:281-364-9695
Mailing Address - Fax:
Practice Address - Street 1:14715 BRISTOL PARK BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1894
Practice Address - Country:US
Practice Address - Phone:405-840-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5917225X00000X
TX117790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist