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NPI Code Detail

MEDICARE: BONNIE JEAN BALDWIN

MEDICARE:   BONNIE JEAN 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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1649802836
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE JEAN BALDWIN
Provider Business Mailing Address
First Line : 25719 CARR RD
Second Line :
City : WEST HARRISON
State : IN
Zip : 47060-9147
Country : US
Telephone Number : 724-549-8108
Fax Number :
Provider Business Practice Location Address
First Line : 25719 CARR RD
Second Line :
City : WEST HARRISON
State : IN
Zip : 47060-9147
Country : US
Telephone Number : 724-549-8108
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2020
Last Update Date : 02/06/2020

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Directions to “ BONNIE JEAN BALDWIN ” Practice Location

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