Provider Demographics
NPI:1720588569
Name:MCGILL, ABIGAIL MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:MARIE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:MARIE
Other - Last Name:ROBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4420 PEACHTREE RD NE APT 2319
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2764
Mailing Address - Country:US
Mailing Address - Phone:317-670-4437
Mailing Address - Fax:
Practice Address - Street 1:4420 PEACHTREE RD NE APT 2319
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2764
Practice Address - Country:US
Practice Address - Phone:317-670-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19389225X00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist