Provider Demographics
NPI:1619443702
Name:COLE, ABIGAIL KATHLEEN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:KATHLEEN
Last Name:COLE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 SANTA CLARA AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2945
Mailing Address - Country:US
Mailing Address - Phone:505-507-2436
Mailing Address - Fax:
Practice Address - Street 1:2820 SANTA CLARA AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2945
Practice Address - Country:US
Practice Address - Phone:505-507-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty