Healthcare Provider Details

I. General information

NPI: 1881064863
Provider Name (Legal Business Name): ABIGAIL HINE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 S GREELEY HWY STE E
CHEYENNE WY
82007-3057
US

IV. Provider business mailing address

630 COWAN ST
FORT COLLINS CO
80524-3156
US

V. Phone/Fax

Practice location:
  • Phone: 307-634-2109
  • Fax:
Mailing address:
  • Phone: 203-641-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberTPS
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: