Provider Demographics
NPI:1720216294
Name:HOLWEGNER, ABBY LYNN (OTRL)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:LYNN
Last Name:HOLWEGNER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:LYNN
Other - Last Name:HEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:4140 CENTENNIAL HILLS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3265
Mailing Address - Country:US
Mailing Address - Phone:307-265-7205
Mailing Address - Fax:307-235-6262
Practice Address - Street 1:4070 PLAZA DR STE 107
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4296
Practice Address - Country:US
Practice Address - Phone:307-265-7205
Practice Address - Fax:307-235-6262
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW23779Medicare PIN