MEDICARE: TIFFANY BALDWIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2015025520	MO

General Provider Information

NPI Number	:	1356798508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY BALDWIN

Provider Business Mailing Address
First Line	:	522 RIFLE RIDGE DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-4858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 CRAIG RD STE 160
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7173
Country	:	US
Telephone Number	:	314-305-1407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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Directions to “ TIFFANY BALDWIN ” Practice Location

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