MEDICARE: MRS. MICHELLE ANNE BAUGHER ATC

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

General Provider Information

NPI Number	:	1376504761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE ANNE BAUGHER ATC

Provider Business Mailing Address
First Line	:	1808 SMITH LN
Second Line	:
City	:	GRANDVIEW
State	:	WA
Zip	:	98930-1137
Country	:	US
Telephone Number	:	509-882-4297
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 SOUTH WASCO
Second Line	:
City	:	WAPATO
State	:	WA
Zip	:	98951
Country	:	US
Telephone Number	:	509-877-3138
Fax Number	:	509-877-4334

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/08/2007

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