Provider Demographics
NPI:1417794041
Name:RAUTTER, ABIGAIL ALICIA
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ALICIA
Last Name:RAUTTER
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 1:130 CORRIDOR RD # 3929
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-7850
Mailing Address - Country:US
Mailing Address - Phone:904-638-6388
Mailing Address - Fax:
Practice Address - Street 1:130 CORRIDOR RD UNIT 3292
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32004-7833
Practice Address - Country:US
Practice Address - Phone:904-638-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician