Provider Demographics
NPI:1366779449
Name:MANN, ANGELA M (OTR/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:369 E COVE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8040
Mailing Address - Country:US
Mailing Address - Phone:651-470-4982
Mailing Address - Fax:
Practice Address - Street 1:3915 GOLDEN VALLEY RD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4249
Practice Address - Country:US
Practice Address - Phone:763-520-0408
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist