Provider Demographics
NPI:1215919774
Name:KIDD, ANGELA KAY (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:KIDD
Suffix:
Gender:F
Credentials:COTA
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Mailing Address - Street 1:1650 LYNDON FARM CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5002
Mailing Address - Country:US
Mailing Address - Phone:504-412-5847
Mailing Address - Fax:502-412-0407
Practice Address - Street 1:1332 WATERFORD XING CIR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6009
Practice Address - Country:US
Practice Address - Phone:574-534-3920
Practice Address - Fax:574-534-7548
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000947A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant