Provider Demographics
NPI:1740887694
Name:FENNELL, ABBY LOU (OT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LOU
Last Name:FENNELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:LOU
Other - Last Name:HINDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3444 MASONIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-441-8329
Mailing Address - Fax:318-441-8339
Practice Address - Street 1:429 ROCKY BAYOU DRIVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-545-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2619969Medicaid