Provider Demographics
NPI:1205416419
Name:BABY BEAR CRANIAL CLINIC
Entity Type:Organization
Organization Name:BABY BEAR CRANIAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-257-4902
Mailing Address - Street 1:2535 NORTHERN RD STE B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8753
Mailing Address - Country:US
Mailing Address - Phone:920-257-4902
Mailing Address - Fax:949-561-4308
Practice Address - Street 1:2535 NORTHERN RD STE B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8753
Practice Address - Country:US
Practice Address - Phone:920-257-4902
Practice Address - Fax:949-561-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment