Provider Demographics
NPI:1851514681
Name:TALMADGE, EDIE BARR (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:EDIE
Middle Name:BARR
Last Name:TALMADGE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 CARELL AVE
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2127
Mailing Address - Country:US
Mailing Address - Phone:805-449-3481
Mailing Address - Fax:805-449-3488
Practice Address - Street 1:145 HODENCAMP RD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5810
Practice Address - Country:US
Practice Address - Phone:805-449-3481
Practice Address - Fax:805-449-3481
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist