Provider Demographics
NPI:1720626005
Name:STELZER, ABIGAIL JOY
Entity Type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:JOY
Last Name:STELZER
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 1:1122 SE 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2525
Mailing Address - Country:US
Mailing Address - Phone:541-705-7841
Mailing Address - Fax:
Practice Address - Street 1:17221 SE DIVISION ST UNIT 23
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1240
Practice Address - Country:US
Practice Address - Phone:541-705-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist