Provider Demographics
NPI:1104248715
Name:MAISS, BABETTE (CMT,CLT)
Entity type:Individual
Prefix:MS
First Name:BABETTE
Middle Name:
Last Name:MAISS
Suffix:
Gender:F
Credentials:CMT,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 GREEN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9231
Mailing Address - Country:US
Mailing Address - Phone:530-321-5668
Mailing Address - Fax:
Practice Address - Street 1:13 WILLIAMSBURG LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2225
Practice Address - Country:US
Practice Address - Phone:530-321-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31518174400000X
CAC70689224900000X
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialist
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty