MEDICARE: MS. CONSTANCE ANN BAUER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	312	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000662660	OTHER	MT	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194766626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSTANCE ANN BAUER OTR/L

Provider Business Mailing Address
First Line	:	19215 HOULE CREEK RD
Second Line	:
City	:	FRENCHTOWN
State	:	MT
Zip	:	59834-9610
Country	:	US
Telephone Number	:	406-370-6758
Fax Number	:	406-626-4659

Provider Business Practice Location Address
First Line	:	19215 HOULE CREEK RD
Second Line	:
City	:	FRENCHTOWN
State	:	MT
Zip	:	59834-9610
Country	:	US
Telephone Number	:	406-370-6758
Fax Number	:	406-626-4659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	10/29/2007

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