Provider Demographics
NPI:1831808138
Name:WOOSTER, ABIGAIL LEIGH
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEIGH
Last Name:WOOSTER
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 1:265 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-1120
Mailing Address - Country:US
Mailing Address - Phone:330-843-6173
Mailing Address - Fax:
Practice Address - Street 1:265 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-1120
Practice Address - Country:US
Practice Address - Phone:330-843-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV125553494Medicaid
WV1821206228Medicaid
WV1356607394Medicaid