Healthcare Provider Details

I. General information

NPI: 1720266109
Provider Name (Legal Business Name): ABBY RENEE VANDER VEER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WIND HAVEN DR STE 100
NICHOLASVILLE KY
40356-8010
US

IV. Provider business mailing address

109 WIND HAVEN DR STE 100
NICHOLASVILLE KY
40356-8010
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-2273
  • Fax:
Mailing address:
  • Phone: 859-224-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number252576
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12797
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number252576
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: