Provider Demographics
NPI:1215924717
Name:ANGELA COMSTOCK
Entity type:Organization
Organization Name:ANGELA COMSTOCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CECILE
Authorized Official - Last Name:COMSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, BCIA-C
Authorized Official - Phone:417-540-2756
Mailing Address - Street 1:1521 S HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1242
Mailing Address - Country:US
Mailing Address - Phone:417-540-2756
Mailing Address - Fax:877-423-3650
Practice Address - Street 1:1521 S HIGHVIEW AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1242
Practice Address - Country:US
Practice Address - Phone:417-540-2756
Practice Address - Fax:877-423-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002005225X00000X
OKOT 260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty