Provider Demographics
NPI:1306428743
Name:ABRAM, DUSTIN (OTR/L, CDRS, CAPS)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:ABRAM
Suffix:
Gender:M
Credentials:OTR/L, CDRS, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 IVY CREST WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4475
Mailing Address - Country:US
Mailing Address - Phone:401-216-9564
Mailing Address - Fax:
Practice Address - Street 1:3521 IVY CREST WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4475
Practice Address - Country:US
Practice Address - Phone:470-326-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification