Provider Demographics
NPI:1922731603
Name:ABDOU, HAGR
Entity Type:Individual
Prefix:
First Name:HAGR
Middle Name:
Last Name:ABDOU
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 1:4030 BUTTONBUSH DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-5019
Mailing Address - Country:US
Mailing Address - Phone:347-585-4476
Mailing Address - Fax:
Practice Address - Street 1:4030 BUTTONBUSH DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-5019
Practice Address - Country:US
Practice Address - Phone:347-585-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026547225X00000X
FL22564225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37722830Medicaid