Provider Demographics
NPI:1255479820
Name:BAUER, JOANNA M (OTR)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:M
Last Name:BAUER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1737
Mailing Address - Country:US
Mailing Address - Phone:508-869-2149
Mailing Address - Fax:
Practice Address - Street 1:424 EDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1737
Practice Address - Country:US
Practice Address - Phone:508-869-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6906225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOG0031OtherBCBSMA GROUP NUMBER
MA0396621OtherMASSHEALTH
MAOT0104OtherBCBSMA PROVIDER NUMBER
MABA Y69379Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID