Healthcare Provider Details

I. General information

NPI: 1831617406
Provider Name (Legal Business Name): ABIGAIL ENSIGN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6942 SILVER LINDEN ST
BETHESDA MD
20817-1576
US

IV. Provider business mailing address

6942 SILVER LINDEN ST
BETHESDA MD
20817-1576
US

V. Phone/Fax

Practice location:
  • Phone: 301-908-9588
  • Fax:
Mailing address:
  • Phone: 301-908-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT100200015
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: