Provider Demographics
NPI:1790138006
Name:ABATE, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:ABATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W SUPERIOR ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3506
Mailing Address - Country:US
Mailing Address - Phone:815-712-0513
Mailing Address - Fax:
Practice Address - Street 1:122 W SUPERIOR ST APT 2E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3506
Practice Address - Country:US
Practice Address - Phone:815-712-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist