Provider Demographics
NPI:1558352104
Name:BUENCONSEJO, ABIGAIL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:
Last Name:BUENCONSEJO
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 1:2872 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1669
Mailing Address - Country:US
Mailing Address - Phone:260-497-0838
Mailing Address - Fax:260-497-9088
Practice Address - Street 1:2872 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1669
Practice Address - Country:US
Practice Address - Phone:260-497-0838
Practice Address - Fax:260-497-9088
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225XE1200X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN179100AMedicare ID - Type UnspecifiedOCCUPATIONAL THERAPY