Mind Body OT LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

MIND BODY OT LLC

Practice address

201 Gateway Dr.
Ste 300
Beaver Dam, WI 53916-9176

Phone

(920) 763-3534

NPI assigned

Mar 20, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan M Baumann, OTNPI 1750642583

Title

Owner

Phone

(920) 763-3534

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Marie Baumann, OTR

  • Occupational Therapist
  • Beaver Dam, WI
  • NPI 1750642583
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1972063691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W9018 COUNTY RD S",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539169680",
            "telephone_number": "920-763-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 GATEWAY DR.",
            "address_2": "STE 300",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539169176",
            "telephone_number": "920-763-3534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY OT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-20",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "BAUMANN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-763-3534",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "susanb3@hotmail.com",
            "affiliation": "N",
            "address_1": "201 Gateway Dr.",
            "address_2": "Ste 300",
            "city": "Beaver dam",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539169176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Abby Sue Millard
• Eric D Miller, MD
• Jennifer M Miller, AUD
• Linda G Miller, CRNA
• Paula Miller, PTA
• Robert R Moauro Jr., PT, DPT
• Megan M Moore, PT, DPT
• Amy J Muchow, MD
• My Helpers Care LLC
• Tammy S Narance, MS LPC

• Rehabilitation Clinic/Center in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Rehabilitation Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.