Provider Demographics
NPI:1932248861
Name:FOLCZYK, ANGELA FULKERSON (OTR)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:FULKERSON
Last Name:FOLCZYK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6464
Mailing Address - Country:US
Mailing Address - Phone:859-539-2844
Mailing Address - Fax:859-272-7311
Practice Address - Street 1:856 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6464
Practice Address - Country:US
Practice Address - Phone:859-539-2844
Practice Address - Fax:859-272-7311
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY136514225X00000X
KYR2280225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics