Healthcare Provider Details

I. General information

NPI: 1467315739
Provider Name (Legal Business Name): ABIGAIL HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 LOUISIANA BLVD NE STE D
ALBUQUERQUE NM
87113-2121
US

IV. Provider business mailing address

3600 KARNER DR
SHAKOPEE MN
55379-8125
US

V. Phone/Fax

Practice location:
  • Phone: 505-336-2874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2025-0202
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: