Provider Demographics
NPI:1417754904
Name:MAXWELL, ABBY NICOLE (COTA)
Entity type:Individual
Prefix:MS
First Name:ABBY
Middle Name:NICOLE
Last Name:MAXWELL
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 SIENA HEIGHTS DR APT 1112
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3876
Mailing Address - Country:US
Mailing Address - Phone:260-494-5918
Mailing Address - Fax:
Practice Address - Street 1:2951 SIENA HEIGHTS DR APT 1112
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3876
Practice Address - Country:US
Practice Address - Phone:260-494-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOTA-3606224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant