MEDICARE: ABIGAIL VILLANUEVA OTR L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	6772	NC

General Provider Information

NPI Number	:	1417115346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL VILLANUEVA OTR L

Provider Business Mailing Address
First Line	:	598 INDIAN TRAIL RD S
Second Line	:	141
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-8689
Country	:	US
Telephone Number	:	704-975-7008
Fax Number	:	704-821-0570

Provider Business Practice Location Address
First Line	:	598 INDIAN TRAIL RD S
Second Line	:	141
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-8689
Country	:	US
Telephone Number	:	704-975-7008
Fax Number	:	704-821-0570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	04/09/2026

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