Provider Demographics
NPI:1215090980
Name:FITZGERALD, ANGELA MARIE (MS, OTR, CHT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS, OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11848 ROCK LANDING DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4425
Mailing Address - Country:US
Mailing Address - Phone:757-873-8839
Mailing Address - Fax:
Practice Address - Street 1:11848 ROCK LANDING DR
Practice Address - Street 2:SUITE 303
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4425
Practice Address - Country:US
Practice Address - Phone:757-873-8839
Practice Address - Fax:757-873-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002324225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VASC0001004Medicare PIN