Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT1265 | AL |
NPI | 1003016239 |
---|---|
Provider Name | Thomas D Abbott |
First Address | Fairhope, AL 36532-6939 |
Second Address | Montrose, AL 36559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 29/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P29673 | (02) | AL |