Provider Demographics
NPI:1164728259
Name:BAUM, STEPHEN HAROLD (OT/MPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:HAROLD
Last Name:BAUM
Suffix:
Gender:M
Credentials:OT/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 S WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6650
Mailing Address - Country:US
Mailing Address - Phone:325-437-6212
Mailing Address - Fax:325-695-2629
Practice Address - Street 1:3202 S WILLIS ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6650
Practice Address - Country:US
Practice Address - Phone:325-437-6212
Practice Address - Fax:325-695-2629
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN108135225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist