Healthcare Provider Details

I. General information

NPI: 1003746843
Provider Name (Legal Business Name): ABIGAIL ROSE O'KOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E JENKINS AVE
COLUMBUS OH
43207-1318
US

IV. Provider business mailing address

4790 DOVE TRAIL LN E
CANAL WINCHESTER OH
43110-3702
US

V. Phone/Fax

Practice location:
  • Phone: 380-230-5330
  • Fax:
Mailing address:
  • Phone: 614-530-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: