Provider Demographics
NPI:1740952258
Name:MENEFEE, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:MENEFEE
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 1:730 COREY DR
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401
Mailing Address - Country:US
Mailing Address - Phone:641-420-7168
Mailing Address - Fax:
Practice Address - Street 1:415 IA-7
Practice Address - Street 2:
Practice Address - City:NEWELL
Practice Address - State:IA
Practice Address - Zip Code:50568
Practice Address - Country:US
Practice Address - Phone:712-272-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant