Provider Demographics
NPI:1255866174
Name:BAUWIN, TINA (COTA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BAUWIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 KIOWA DR E
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-9567
Mailing Address - Country:US
Mailing Address - Phone:940-595-6614
Mailing Address - Fax:
Practice Address - Street 1:541 KIOWA DR E
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-9567
Practice Address - Country:US
Practice Address - Phone:940-595-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206233224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant