Healthcare Provider Details

I. General information

NPI: 1306925276
Provider Name (Legal Business Name): TAMMY M BAUM OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 EASTERN PARKWAY
LOUISVILLE KY
40217-1501
US

IV. Provider business mailing address

9601 GUTENBERG RD
LOUISVILLE KY
40299
US

V. Phone/Fax

Practice location:
  • Phone: 502-635-6397
  • Fax: 502-635-1147
Mailing address:
  • Phone: 502-240-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKYR2509
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: