Provider Demographics
NPI:1558346353
Name:JORGENSEN, ABBY L (OT)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:L
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0435
Mailing Address - Country:US
Mailing Address - Phone:605-842-7188
Mailing Address - Fax:605-842-7189
Practice Address - Street 1:825 E 8TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2633
Practice Address - Country:US
Practice Address - Phone:605-842-7188
Practice Address - Fax:605-842-7189
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD10134OtherAVERA HEALTH PLAN
SD28717OtherSANDFORD HEALTH PLAN
SD5836152OtherMEDICAID
SD4995629OtherWELLMARK
SD9245763OtherDAKOTACARE
SD5836150OtherMEDICAID
SD10134OtherAVERA HEALTH PLAN