=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346257938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TINA MARIE BALDWIN OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 05/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2212 OUTER CIRCLE DR
-----------------------------------------------------
City | CRESTWOOD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40014-9113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-836-0701
-----------------------------------------------------
Fax | 502-243-9848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2212 OUTER CIRCLE DR
-----------------------------------------------------
City | CRESTWOOD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40014-9113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-836-0701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 31003152A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | KY-R2001
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------