Provider Demographics
NPI:1992009914
Name:GROPPER-BAUM, LYNNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:GROPPER-BAUM
Suffix:
Gender:F
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:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-0324
Mailing Address - Country:US
Mailing Address - Phone:360-600-7238
Mailing Address - Fax:
Practice Address - Street 1:17208 NE 125TH COURT
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98606-0324
Practice Address - Country:US
Practice Address - Phone:360-600-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWASHINGTON OT 953171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA027801OtherPROFESSIONAL LICENSE