Provider Demographics
NPI:1215969654
Name:FARB, ANGELA (OT)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:FARB
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 E MISSION AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1049
Mailing Address - Country:US
Mailing Address - Phone:509-444-5678
Mailing Address - Fax:
Practice Address - Street 1:12509 E MISSION AVE
Practice Address - Street 2:STE. 202
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1049
Practice Address - Country:US
Practice Address - Phone:509-444-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8339624Medicaid
WA8339624Medicaid