MEDICARE: MRS. EDIE BARR TALMADGE O.T.R.L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2712	CA

General Provider Information

NPI Number	:	1851514681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EDIE BARR TALMADGE O.T.R.L

Provider Business Mailing Address
First Line	:	5860 CARELL AVE
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2127
Country	:	US
Telephone Number	:	805-449-3481
Fax Number	:	805-449-3488

Provider Business Practice Location Address
First Line	:	145 HODENCAMP RD STE 100
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5810
Country	:	US
Telephone Number	:	805-449-3481
Fax Number	:	805-449-3481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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