Provider Demographics
NPI:1033159165
Name:BABIN, DEREK LAYNE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:LAYNE
Last Name:BABIN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 WATERMELON RD
Mailing Address - Street 2:STE E
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5143
Mailing Address - Country:US
Mailing Address - Phone:205-759-2211
Mailing Address - Fax:205-759-2213
Practice Address - Street 1:3835 WATERMELON RD
Practice Address - Street 2:STE A
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5143
Practice Address - Country:US
Practice Address - Phone:205-759-2211
Practice Address - Fax:205-759-2213
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ59090Medicare UPIN