Basic Information
Provider Information | |||||||||
NPI: | 1821311242 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WRIGHT | ||||||||
FirstName: | ABIGAIL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MOT,OTR/L | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HAFFNER | ||||||||
OtherFirstName: | ABIGAIL | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 29D STONEHILL ROAD | ||||||||
Address2: |   | ||||||||
City: | OSWEGO | ||||||||
State: | IL | ||||||||
PostalCode: | 60543 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6305546156 | ||||||||
FaxNumber: | 6305546378 | ||||||||
Practice Location | |||||||||
Address1: | 29D STONEHILL ROAD | ||||||||
Address2: |   | ||||||||
City: | OSWEGO | ||||||||
State: | IL | ||||||||
PostalCode: | 60543 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6305546156 | ||||||||
FaxNumber: | 6305546378 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/12/2010 | ||||||||
LastUpdateDate: | 08/28/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056008609 | IL | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 225X00000X | 056.008609 | IL | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
No ID Information.