Provider Demographics
NPI:1649404955
Name:BABASHOFF, MARY JANE DAVID (MT)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:DAVID
Last Name:BABASHOFF
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 LAHAINALUNA RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1585
Mailing Address - Country:US
Mailing Address - Phone:808-661-7200
Mailing Address - Fax:808-443-0494
Practice Address - Street 1:181 LAHAINALUNA RD STE D
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1585
Practice Address - Country:US
Practice Address - Phone:808-661-7200
Practice Address - Fax:808-443-0494
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-10542225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist