Provider Demographics
NPI:1174779417
Name:SLAGLEY, ANGELA MARIE (OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:SLAGLEY
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2191
Mailing Address - Country:US
Mailing Address - Phone:217-347-3003
Mailing Address - Fax:217-347-3005
Practice Address - Street 1:901 MEDICAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2191
Practice Address - Country:US
Practice Address - Phone:217-347-3003
Practice Address - Fax:217-347-3005
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007361225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
371386095OtherHEALTHLINK
IL2500075OtherBCBS
K52889Medicare UPIN
371386095OtherHEALTHLINK