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General NPI Number Information
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NPI Number | 1457611964
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Entity Type | Individual
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Provider Name | JEANNENE GEMINI BABCOCK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 2161 KALIA RD APT 412
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City | HONOLULU
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State | HI
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Zip | 96815-1909
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Country | US
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Telephone | 520-227-8161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8842
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City | HONOLULU
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State | HI
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Zip | 96830-0842
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Country | US
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Telephone | 520-227-8161
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4346
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License Number State | AZ
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