Provider Demographics
NPI:1518421387
Name:CASTILLO, ABIGAIL KATHERINE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:KATHERINE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 RASCAL XING
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4460
Mailing Address - Country:US
Mailing Address - Phone:636-696-5248
Mailing Address - Fax:
Practice Address - Street 1:901 S NATIONAL AVE # 160
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897-0001
Practice Address - Country:US
Practice Address - Phone:417-836-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer