Provider Demographics
NPI:1609278001
Name:ESCALANTE, ANGELA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:THIELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:715 E CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1962
Mailing Address - Country:US
Mailing Address - Phone:602-448-3904
Mailing Address - Fax:
Practice Address - Street 1:715 E CLAREMONT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1962
Practice Address - Country:US
Practice Address - Phone:602-448-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist