Provider Demographics
NPI:1386069359
Name:SWIDERGAL, ABIGAIL (COTA/L)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:SWIDERGAL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N CONRAD ST
Mailing Address - Street 2:
Mailing Address - City:PEOTONE
Mailing Address - State:IL
Mailing Address - Zip Code:60468-9245
Mailing Address - Country:US
Mailing Address - Phone:708-372-5084
Mailing Address - Fax:
Practice Address - Street 1:23525 W MILTON RD
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-2619
Practice Address - Country:US
Practice Address - Phone:847-226-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003985224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant