Provider Demographics
NPI:1225237811
Name:WEBER, ABIGAIL LEIGH (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEIGH
Last Name:WEBER
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PINEHURST CT
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2342
Mailing Address - Country:US
Mailing Address - Phone:423-257-5076
Mailing Address - Fax:
Practice Address - Street 1:1633 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4115
Practice Address - Country:US
Practice Address - Phone:423-543-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist