Healthcare Provider Details

I. General information

NPI: 1295658771
Provider Name (Legal Business Name): JENNIFER BAUM OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HARRISON AVE UNIT E101
BOSTON MA
02118-2683
US

IV. Provider business mailing address

725 HARRISON AVE UNIT E101
BOSTON MA
02118-2683
US

V. Phone/Fax

Practice location:
  • Phone: 917-670-7534
  • Fax:
Mailing address:
  • Phone: 917-670-7534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8814
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8814
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: