MEDICARE: ANNEMARIE BABCOCK QMHA

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1669876090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNEMARIE BABCOCK QMHA

Provider Business Mailing Address
First Line	:	3203 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3778
Country	:	US
Telephone Number	:	541-880-5500
Fax Number	:	541-880-5513

Provider Business Practice Location Address
First Line	:	3203 VANDENBERG RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3778
Country	:	US
Telephone Number	:	541-880-5500
Fax Number	:	541-880-5513

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

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	03/19/2015

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