Healthcare Provider Details

I. General information

NPI: 1992948293
Provider Name (Legal Business Name): CHRYSTYNA E. BABIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15420 DURANT ST
SILVER SPRING MD
20905-4211
US

IV. Provider business mailing address

15420 DURANT ST
SILVER SPRING MD
20905-4211
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-1119
  • Fax:
Mailing address:
  • Phone: 301-384-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number01561
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119000532
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT25
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: