Timothy J Baumann, OTA

Individual provider Active NPI Occupational Therapy Assistant · Beaver Dam, WI

NPI 1790089795 · NPPES record last updated Jan 5, 2011

Key facts

NPI
1790089795
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
399-27 (WI)
Practice address
W9018 County Rd S
Beaver Dam, WI 53916-9680
Phone
(608) 429-2181
NPI assigned
Jan 5, 2011
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
399-27WIMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
NSH Summit LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 399-27 WI Yes

Addresses

Primary practice location

W9018 County Rd S
Beaver Dam, WI 53916-9680

Mailing address

W9018 County Rd S
Beaver Dam, WI 53916-9680
Phone (608) 429-2181

Other providers in Beaver Dam, WI

All providers in Beaver Dam, WI · Occupational Therapy Assistant in Wisconsin

Sources for this page

Verify at the official NPI Registry.