Provider Demographics
NPI:1144540857
Name:BABCOCK, ANGELA DAWN (LMT)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DAWN
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 MAKAMAKA ST
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2250
Mailing Address - Country:US
Mailing Address - Phone:808-212-1303
Mailing Address - Fax:
Practice Address - Street 1:4-1345 KUHIO HWY
Practice Address - Street 2:STE D
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1600
Practice Address - Country:US
Practice Address - Phone:808-822-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6368173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist