MEDICARE: ABIGAIL CATHERINE MINNICH

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	106S00000X	Behavior Technician	RBT-22-244446	HI

General Provider Information

NPI Number	:	1801505045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL CATHERINE MINNICH

Provider Business Mailing Address
First Line	:	550 KUNEHI ST APT 206
Second Line	:
City	:	KAPOLEI
State	:	HI
Zip	:	96707-2069
Country	:	US
Telephone Number	:	808-674-6641
Fax Number	:

Provider Business Practice Location Address
First Line	:	4788 E ELUA WAY APT D
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3008
Country	:	US
Telephone Number	:	808-674-6641
Fax Number	:

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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Directions to “ ABIGAIL CATHERINE MINNICH ” Practice Location

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