Provider Demographics
NPI:1831133396
Name:ABBOTT, WILLIAM K (CERTIFIED PROSTHETIS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:K
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:CERTIFIED PROSTHETIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2435
Mailing Address - Country:US
Mailing Address - Phone:573-635-0006
Mailing Address - Fax:573-635-2228
Practice Address - Street 1:1735 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2435
Practice Address - Country:US
Practice Address - Phone:573-635-0006
Practice Address - Fax:573-635-2228
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCERTIFIED225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO122475OtherBCBS PROVIDER#
MO433956OtherHEALTHLINK PROVIDER#
MO1261040001Medicare ID - Type UnspecifiedMEDICARE PROVIDER#