=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992185185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL SLAVIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2015
-----------------------------------------------------
Last Update Date | 06/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 790 LAKE ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03222-4548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-744-0275
-----------------------------------------------------
Fax | 603-744-9378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 790 LAKE ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03222-4548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-744-0275
-----------------------------------------------------
Fax | 603-744-9378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 3983
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------