Provider Demographics
NPI:1336629187
Name:CANTRELL, ANGELA MAE (COTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WHISPERING WINDS DR
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-2556
Mailing Address - Country:US
Mailing Address - Phone:903-267-8425
Mailing Address - Fax:
Practice Address - Street 1:1280 SETTLERS RDG
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-2282
Practice Address - Country:US
Practice Address - Phone:972-382-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208849224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant