Provider Demographics
NPI:1629733159
Name:QUARTERMAN, ABIGAIL ELISE (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELISE
Last Name:QUARTERMAN
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 NE 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5644
Mailing Address - Country:US
Mailing Address - Phone:206-375-0293
Mailing Address - Fax:
Practice Address - Street 1:5243 NE 21ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5644
Practice Address - Country:US
Practice Address - Phone:206-375-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR366307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR366307OtherOREGON STATE LICENSURE
WAOT60700455OtherWASHINGTON STATE LICENSURE