Provider Demographics
NPI:1366956070
Name:EDIE, ABBY LYNN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:LYNN
Last Name:EDIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:LYNN
Other - Last Name:FROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 PLANTATION CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1757
Mailing Address - Country:US
Mailing Address - Phone:330-878-7681
Mailing Address - Fax:
Practice Address - Street 1:8884 DANIEL LN NW
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:OH
Practice Address - Zip Code:44680-9700
Practice Address - Country:US
Practice Address - Phone:330-268-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11102225X00000X
OHOT010679225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist