Healthcare Provider Details

I. General information

NPI: 1891024238
Provider Name (Legal Business Name): SARA BETH BALDWIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CSH UNIT 15244 BOX 552
APO AP
96205-5244
US

IV. Provider business mailing address

121ST CSH UNIT 15244 BOX 552
APO AP
96205-5244
US

V. Phone/Fax

Practice location:
  • Phone: 315-736-7377
  • Fax:
Mailing address:
  • Phone: 315-736-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number103102
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number103102
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number103102
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: