Provider Demographics
NPI:1528437365
Name:ABOLT, ABBY MAUREEN (OTR/L)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:MAUREEN
Last Name:ABOLT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52656-9446
Mailing Address - Country:US
Mailing Address - Phone:319-371-7755
Mailing Address - Fax:
Practice Address - Street 1:4961 BUFORD HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3535
Practice Address - Country:US
Practice Address - Phone:404-575-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT006279Medicaid