Basic Information
| Provider Information | |||||||||
| NPI: | 1508419128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEGLEY | ||||||||
| FirstName: | ABIGAILO | ||||||||
| MiddleName: | CHANDLER | ||||||||
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| Credential: | HS ; RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 DEPAUW BLVD STE 3070 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462686135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175166489 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 703 STATE ROUTE 28 | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451505021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138312578 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2019 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-18-57397 | Y |
ID Information
| ID | Type | State | Issuer | Description | RBT-18-57397 | 01 | RBT CERTIFICATE | OTHER |