Provider Demographics
NPI:1205344595
Name:LEISEMANN, ABIGAIL (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:LEISEMANN
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 1:1130 CREEKSIDE DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-8815
Mailing Address - Country:US
Mailing Address - Phone:309-258-9398
Mailing Address - Fax:
Practice Address - Street 1:114 S 79TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1413
Practice Address - Country:US
Practice Address - Phone:309-258-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
WI2248-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer