Provider Demographics
NPI:1639449580
Name:LAWRENCE, BABETTE L
Entity Type:Individual
Prefix:MS
First Name:BABETTE
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 LANTERN RD STE 235
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3106
Mailing Address - Country:US
Mailing Address - Phone:317-576-8410
Mailing Address - Fax:
Practice Address - Street 1:11650 LANTERN RD STE 235
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3106
Practice Address - Country:US
Practice Address - Phone:317-576-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005219A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3100521AOtherINDIANA OCCUPATIONAL THERAPY LICENSE