Provider Demographics
NPI:1912653411
Name:VETETO, ABIGAIL ANN
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ANN
Last Name:VETETO
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 1:1130 ANTLER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2481
Mailing Address - Country:US
Mailing Address - Phone:618-791-8377
Mailing Address - Fax:
Practice Address - Street 1:1130 ANTLER DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2481
Practice Address - Country:US
Practice Address - Phone:618-791-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist