Provider Demographics
NPI:1003016239
Name:ABBOTT, THOMAS D (OT, CHT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6939
Mailing Address - Country:US
Mailing Address - Phone:251-408-7779
Mailing Address - Fax:251-408-7779
Practice Address - Street 1:22873 US HWY 98
Practice Address - Street 2:BUILDING I SUITE 5
Practice Address - City:MONTROSE
Practice Address - State:AL
Practice Address - Zip Code:36559
Practice Address - Country:US
Practice Address - Phone:251-408-7779
Practice Address - Fax:251-408-7779
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALOT1265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051501666Medicare PIN
ALP29673Medicare UPIN