Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31003899A | IN |
N | 225XH1200X | Occupational Therapist - Hand | 31003899A | IN |
NPI | 1265538706 |
---|---|
Provider Name | Jennifer Ann Bayer |
First Address | Roswell, GA 30076-3866 |
Second Address | Indianapolis, IN 46260-2046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 07/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000384790 | ANTHEM HEALTH PLAN (01) | |
200544840 | (05) | IN |
P00703266 | RR MEDICARE (01) | IN |