Provider Demographics
NPI:1962776450
Name:MART, ANGELA MARIE (MOTR/L)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:MART
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 NW PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1628
Mailing Address - Country:US
Mailing Address - Phone:503-939-5204
Mailing Address - Fax:
Practice Address - Street 1:924 NW PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1628
Practice Address - Country:US
Practice Address - Phone:503-939-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR214771225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation