Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 056007361 | IL |
NPI | 1174779417 |
---|---|
Provider Name | Mrs. Angela Marie Slagley |
First Address | Effingham, IL 62401-2191 |
Second Address | Effingham, IL 62401-2191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 02/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2500075 | BCBS (01) | IL |
371386095 | HEALTHLINK (01) | |
K52889 | (02) |