Provider Demographics
NPI:1710080064
Name:BAUER, KRISTI ANNE (OT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ANNE
Last Name:BAUER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 FOXMOOR DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4092
Mailing Address - Country:US
Mailing Address - Phone:630-801-8771
Mailing Address - Fax:
Practice Address - Street 1:2979 FOXMOOR DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4092
Practice Address - Country:US
Practice Address - Phone:630-801-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist