Healthcare Provider Details

I. General information

NPI: 1386571222
Provider Name (Legal Business Name): ABIGAIL TERESA DELORME CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 PETERS CREEK RD APT H
ROANOKE VA
24019-3859
US

IV. Provider business mailing address

1726 RUTROUGH RD SE APT 13
ROANOKE VA
24014-4657
US

V. Phone/Fax

Practice location:
  • Phone: 540-632-8012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number89113
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: