Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CERTIFIED | MO |
NPI | 1831133396 |
---|---|
Provider Name | Mr. William K Abbott |
First Address | Jefferson City, MO 65109-2435 |
Second Address | Jefferson City, MO 65109-2435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122475 | BCBS PROVIDER# (01) | MO |
433956 | HEALTHLINK PROVIDER# (01) | MO |