Healthcare Provider Details

I. General information

NPI: 1134982523
Provider Name (Legal Business Name): ABIGAIL DEBORAH ORTWINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 E 24TH ST
HOLLAND MI
49423-4880
US

IV. Provider business mailing address

373 E 24TH ST
HOLLAND MI
49423-4880
US

V. Phone/Fax

Practice location:
  • Phone: 616-494-2032
  • Fax:
Mailing address:
  • Phone: 616-494-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: