Healthcare Provider Details

I. General information

NPI: 1710881214
Provider Name (Legal Business Name): ABIGAIL MAE BARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CARNEGIE BLVD STE 220A
MALVERN PA
19355-0367
US

IV. Provider business mailing address

1600 SWAN RD
ATGLEN PA
19310-1730
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-9999
  • Fax:
Mailing address:
  • Phone: 610-314-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC021814
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: