Provider Demographics
NPI:1487538492
Name:LAWSON, ANGEAL COURTNEY
Entity type:Individual
Prefix:
First Name:ANGEAL
Middle Name:COURTNEY
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SHADY RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-7553
Mailing Address - Country:US
Mailing Address - Phone:276-439-9141
Mailing Address - Fax:
Practice Address - Street 1:282 WESTGATE MALL CIR # 282
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-0030
Practice Address - Country:US
Practice Address - Phone:276-546-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001401224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant