Provider Demographics
NPI:1891494837
Name:RABY, AUTUMN LEIGH
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LEIGH
Last Name:RABY
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 1:240 WILLOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-5180
Mailing Address - Country:US
Mailing Address - Phone:864-553-9768
Mailing Address - Fax:
Practice Address - Street 1:240 WILLOW RIDGE LN
Practice Address - Street 2:
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-5180
Practice Address - Country:US
Practice Address - Phone:864-553-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant