Provider Demographics
NPI:1932654456
Name:CRESCITELLI, ABIGAIL (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:CRESCITELLI
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CAROLYN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1062
Mailing Address - Country:US
Mailing Address - Phone:413-588-4981
Mailing Address - Fax:
Practice Address - Street 1:5151 PARK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1000
Practice Address - Country:US
Practice Address - Phone:203-371-7999
Practice Address - Fax:203-365-4704
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT15702255A2300X
2255A2300X, 390200000X
CT0015992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program