Provider Demographics
NPI:1588393797
Name:THARP, ANGELA SUZANNE (OTD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUZANNE
Last Name:THARP
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 GARDENIA CT
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9079
Mailing Address - Country:US
Mailing Address - Phone:765-430-3789
Mailing Address - Fax:
Practice Address - Street 1:5400 GARDENIA CT
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-9079
Practice Address - Country:US
Practice Address - Phone:765-430-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007720A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist