Provider Demographics
NPI:1659325439
Name:BACHMAN, GRETCHEN LYNN (OTR L MBS CHT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LYNN
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:OTR L MBS CHT
Other - Prefix:MS
Other - First Name:GRETCHEN
Other - Middle Name:LYNN
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L MBS CHT
Mailing Address - Street 1:PO BOX 271429
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1429
Mailing Address - Country:US
Mailing Address - Phone:602-385-2115
Mailing Address - Fax:480-422-6551
Practice Address - Street 1:690 N COFCO CENTER CT
Practice Address - Street 2:SUITE 270
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6462
Practice Address - Country:US
Practice Address - Phone:602-393-1010
Practice Address - Fax:602-393-1011
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00404837OtherRAILROAD MEDICARE PTAN
AZ497702Medicaid
AZ111211Medicare PIN