Provider Demographics
NPI:1194193961
Name:IZZO, ABIGAIL (COTA)
Entity Type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:
Last Name:IZZO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7086
Mailing Address - Country:US
Mailing Address - Phone:518-843-8365
Mailing Address - Fax:
Practice Address - Street 1:315 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7086
Practice Address - Country:US
Practice Address - Phone:518-843-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008489-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics