Provider Demographics
NPI:1790497279
Name:LAGORE, ABIGAYLE LYNNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ABIGAYLE
Middle Name:LYNNE
Last Name:LAGORE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 POWHATAN DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529-2137
Mailing Address - Country:US
Mailing Address - Phone:573-694-8129
Mailing Address - Fax:
Practice Address - Street 1:416 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521-9008
Practice Address - Country:US
Practice Address - Phone:870-283-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant