Provider Demographics
NPI:1063215135
Name:DECLINES, ABIGAIL (OTR/L)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:DECLINES
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PALATINE APT 225
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-7613
Mailing Address - Country:US
Mailing Address - Phone:916-271-9721
Mailing Address - Fax:
Practice Address - Street 1:30131 TOWN CENTER DR STE 135
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2010
Practice Address - Country:US
Practice Address - Phone:949-594-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist