MEDICARE: DIANE M BABB O.T.

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	OC002953L	PA

General Provider Information

NPI Number	:	1689825481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M BABB O.T.

Provider Business Mailing Address
First Line	:	109 CLOVER LEAF LN
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1928
Country	:	US
Telephone Number	:	215-699-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 CLOVER LEAF LN
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1928
Country	:	US
Telephone Number	:	215-699-2558
Fax Number	:

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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