Provider Demographics
NPI:1386837854
Name:BURT, ABIGAIL MARIE (MA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE
Last Name:BURT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NE IRVING ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2243
Mailing Address - Country:US
Mailing Address - Phone:503-258-4200
Mailing Address - Fax:503-233-4359
Practice Address - Street 1:1500 NE IRVING ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2243
Practice Address - Country:US
Practice Address - Phone:503-258-4200
Practice Address - Fax:503-233-4359
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program