Provider Demographics
NPI:1336465152
Name:BAUMGARTNER, THOMAS L SR (OTR/L)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:BAUMGARTNER
Suffix:SR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29017 102ND ST.
Mailing Address - Street 2:
Mailing Address - City:POLLOCK
Mailing Address - State:SD
Mailing Address - Zip Code:57648
Mailing Address - Country:US
Mailing Address - Phone:605-889-2335
Mailing Address - Fax:605-889-2335
Practice Address - Street 1:29017 102ND ST
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:SD
Practice Address - Zip Code:57648
Practice Address - Country:US
Practice Address - Phone:605-889-2335
Practice Address - Fax:605-889-2335
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist