Provider Demographics
NPI:1306467568
Name:BEATY, ABIGAIL (COTA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BEATY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 FOSTER ST APT 106
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3123
Mailing Address - Country:US
Mailing Address - Phone:913-286-0557
Mailing Address - Fax:
Practice Address - Street 1:6104 FOSTER ST APT 106
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-3123
Practice Address - Country:US
Practice Address - Phone:913-286-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01529224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant