Provider Demographics
NPI:1609317254
Name:LADEN, ABIGAIL MARY (LMT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARY
Last Name:LADEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14-4330 PAHOA KAPOHO RD
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-7925
Mailing Address - Country:US
Mailing Address - Phone:607-319-1883
Mailing Address - Fax:
Practice Address - Street 1:14-4330 PAHOA KAPOHO RD
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-7925
Practice Address - Country:US
Practice Address - Phone:607-319-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist