Provider Demographics
NPI:1750859021
Name:HUBER, ABIGAIL SUZANN (COTA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:SUZANN
Last Name:HUBER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14305 BLANTON ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7568
Mailing Address - Country:US
Mailing Address - Phone:806-674-0035
Mailing Address - Fax:
Practice Address - Street 1:14305 BLANTON ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-7568
Practice Address - Country:US
Practice Address - Phone:806-674-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215254224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant