Provider Demographics
NPI:1366902694
Name:GRABBERT, ABBIE MICHELLE
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:MICHELLE
Last Name:GRABBERT
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 1:1109 METALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2635
Mailing Address - Country:US
Mailing Address - Phone:502-460-3420
Mailing Address - Fax:
Practice Address - Street 1:1109 METALWOOD DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2635
Practice Address - Country:US
Practice Address - Phone:502-460-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201097088222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist