MEDICARE: ABIGAIL RANCOUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1245017482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL RANCOUR

Provider Business Mailing Address
First Line	:	403B YANCEY ST
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-7148
Country	:	US
Telephone Number	:	757-761-8153
Fax Number	:

Provider Business Practice Location Address
First Line	:	403B YANCEY ST
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-7148
Country	:	US
Telephone Number	:	757-761-8153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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