Provider Demographics
NPI:1316177942
Name:MOCKENHAUPT, ABBY E (OTR/L)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:E
Last Name:MOCKENHAUPT
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 1:604 LIBERTY ST
Mailing Address - Street 2:STE.229
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 LIBERTY ST
Practice Address - Street 2:STE.229
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1775
Practice Address - Country:US
Practice Address - Phone:644-162-1112
Practice Address - Fax:641-621-1177
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist