Provider Demographics
NPI:1679829717
Name:MAXWELL, ABIGAIL LOUISE (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:LOUISE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FIRST AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59845
Mailing Address - Country:US
Mailing Address - Phone:406-741-2992
Mailing Address - Fax:406-741-2994
Practice Address - Street 1:600 FIRST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59845
Practice Address - Country:US
Practice Address - Phone:406-741-2992
Practice Address - Fax:406-741-2994
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT#1114225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist