Provider Demographics
NPI:1730222696
Name:EASTER, BABBIE BRAE (OTR)
Entity type:Individual
Prefix:
First Name:BABBIE
Middle Name:BRAE
Last Name:EASTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 HOLLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1932
Mailing Address - Country:US
Mailing Address - Phone:317-507-3574
Mailing Address - Fax:317-271-5011
Practice Address - Street 1:8837 HOLLOWOOD DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1932
Practice Address - Country:US
Practice Address - Phone:317-507-3574
Practice Address - Fax:317-271-5011
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000202A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200402120AMedicaid