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General NPI Number Information
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NPI Number | 1063194769
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Entity Type | Individual
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Provider Name | ABIGAIL LILLIAN SELF OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 4575 BYRD DR
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City | LOVELAND
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State | CO
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Zip | 80538-7198
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Country | US
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Telephone | 307-920-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 2366 SAPPHIRE ST
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City | LOVELAND
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State | CO
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Zip | 80537-2022
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Country | US
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Telephone | 724-470-3676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number | OT.0007764
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License Number State | CO
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