MEDICARE: MS. LAUREN BAUMER ATC, LAT

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	2008014719	MO

General Provider Information

NPI Number	:	1881934479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN BAUMER ATC, LAT

Provider Business Mailing Address
First Line	:	231 W LOCKWOOD AVE
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 WILLOWBROOK DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-2148
Country	:	US
Telephone Number	:	314-839-5364
Fax Number	:

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

Provider Enumeration Date	:	02/19/2013
Last Update Date	:	02/19/2013

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