=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699558882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABBIGAIL THALER CBD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 09/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 08048 M 40
-----------------------------------------------------
City | GOBLES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49055-9080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-767-6659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 08048 M 40
-----------------------------------------------------
City | GOBLES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49055-9080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-767-6659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number | ATH-108708
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------