Healthcare Provider Details

I. General information

NPI: 1003016239
Provider Name (Legal Business Name): THOMAS D ABBOTT OT, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22873 US HWY 98 BUILDING I SUITE 5
MONTROSE AL
36559
US

IV. Provider business mailing address

8826 LAKE VIEW DR
FAIRHOPE AL
36532-6939
US

V. Phone/Fax

Practice location:
  • Phone: 251-408-7779
  • Fax: 251-408-7779
Mailing address:
  • Phone: 251-408-7779
  • Fax: 251-408-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1265
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: