Provider Demographics
NPI:1497351100
Name:SUCH, ABIGALE ROSE (OTR)
Entity Type:Individual
Prefix:
First Name:ABIGALE
Middle Name:ROSE
Last Name:SUCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALTA ST APT 1308
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1048
Mailing Address - Country:US
Mailing Address - Phone:865-804-6957
Mailing Address - Fax:
Practice Address - Street 1:1209 WESTOVER DR UNIT 3
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-5397
Practice Address - Country:US
Practice Address - Phone:386-325-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist