Provider Demographics
NPI:1750859641
Name:BAUMER, LESLEY (OTR)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:BAUMER
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:W3101 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:VULCAN
Mailing Address - State:MI
Mailing Address - Zip Code:49892-8290
Mailing Address - Country:US
Mailing Address - Phone:906-282-1653
Mailing Address - Fax:
Practice Address - Street 1:1820 MARYS WAY
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-4248
Practice Address - Country:US
Practice Address - Phone:906-282-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist