Provider Demographics
NPI:1083184311
Name:HAVARD, ABBY
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:HAVARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 SIXTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3606
Mailing Address - Country:US
Mailing Address - Phone:662-719-6700
Mailing Address - Fax:
Practice Address - Street 1:DSU BOX A3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38733
Practice Address - Country:US
Practice Address - Phone:662-719-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSAT0582OtherSTATE LICENSURE