Provider Demographics
NPI:1457873713
Name:KLEMM, ABIGAIL GRACE (MT-BC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GRACE
Last Name:KLEMM
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:KLEMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT-BC
Mailing Address - Street 1:7305 CREST LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-2015
Mailing Address - Country:US
Mailing Address - Phone:317-525-5639
Mailing Address - Fax:
Practice Address - Street 1:8447 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4743
Practice Address - Country:US
Practice Address - Phone:513-474-6064
Practice Address - Fax:513-474-6064
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2017-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12332225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist