Provider Demographics
NPI:1275148587
Name:MOUL, ABIGAIL ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELIZABETH
Last Name:MOUL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4701
Mailing Address - Country:US
Mailing Address - Phone:757-508-6889
Mailing Address - Fax:
Practice Address - Street 1:PENINSULA DEL REY
Practice Address - Street 2:165 PIERCE ST
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1984
Practice Address - Country:US
Practice Address - Phone:650-741-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist