Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | KY-R5901 | KY |
NPI | 1003214529 |
---|---|
Provider Name | Matthew Baumann |
First Address | San Antonio, TX 78209-4960 |
Second Address | San Antonio, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2014 |
Last Update Date | 16/12/2014 |