Provider Demographics
NPI:1730672882
Name:BAUCCO, CHRISTINE (ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BAUCCO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2817
Mailing Address - Country:US
Mailing Address - Phone:440-478-2856
Mailing Address - Fax:
Practice Address - Street 1:5419 SUMMIT RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2817
Practice Address - Country:US
Practice Address - Phone:440-478-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20000327312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer