Provider Demographics
NPI:1790816577
Name:BABB, ALTHEA EILLEEN
Entity Type:Individual
Prefix:MS
First Name:ALTHEA
Middle Name:EILLEEN
Last Name:BABB
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 1:5411 TYRONE AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5101
Mailing Address - Country:US
Mailing Address - Phone:818-598-6923
Mailing Address - Fax:818-598-6971
Practice Address - Street 1:7621 CANOGA AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-4912
Practice Address - Country:US
Practice Address - Phone:818-598-6923
Practice Address - Fax:818-598-0671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner