Provider Demographics
NPI:1679396287
Name:DETWEILER, ABIGAIL (ATR-P)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:DETWEILER
Suffix:
Gender:F
Credentials:ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 20TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3904
Mailing Address - Country:US
Mailing Address - Phone:423-464-6006
Mailing Address - Fax:
Practice Address - Street 1:1075 BLYTHE AVE SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-2948
Practice Address - Country:US
Practice Address - Phone:423-464-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24-376221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist