Healthcare Provider Details

I. General information

NPI: 1457036154
Provider Name (Legal Business Name): SHELBI LYNN BAUER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLLEGE PARK AVE
DAYTON OH
45469-0001
US

IV. Provider business mailing address

2822 VARSITY DR
BEAVERCREEK OH
45431-8549
US

V. Phone/Fax

Practice location:
  • Phone: 937-478-3531
  • Fax:
Mailing address:
  • Phone: 937-478-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007152
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: