Provider Demographics
NPI:1992584296
Name:DEESE, ABIGAIL (OTR/L)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:DEESE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BASS PLANTATION DR APT 1502
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5760
Mailing Address - Country:US
Mailing Address - Phone:478-973-9679
Mailing Address - Fax:
Practice Address - Street 1:3351 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2587
Practice Address - Country:US
Practice Address - Phone:478-973-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist