MEDICARE: KERSTIN BAUN MPH, OTR/L

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	225X00000X	Occupational Therapist	993152	OR

General Provider Information

NPI Number	:	1992074785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERSTIN BAUN MPH, OTR/L

Provider Business Mailing Address
First Line	:	9370 SW GREENBURG RD STE M
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-5408
Country	:	US
Telephone Number	:	503-200-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	9370 SW GREENBURG RD STE M
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-5408
Country	:	US
Telephone Number	:	503-200-5750
Fax Number	:

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

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/22/2011

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