Provider Demographics
NPI:1326692278
Name:WALDO, ABIGAIL MICHELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MICHELLE
Last Name:WALDO
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 1:4545 JEFFERSON ST APT 105
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3454
Mailing Address - Country:US
Mailing Address - Phone:913-558-3572
Mailing Address - Fax:
Practice Address - Street 1:5420 W 151ST ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8713
Practice Address - Country:US
Practice Address - Phone:913-219-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03356225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics