Provider Demographics
NPI:1669223939
Name:BAUM, NATHALIA ELEANORLOUISE (OTR/L)
Entity type:Individual
Prefix:
First Name:NATHALIA
Middle Name:ELEANORLOUISE
Last Name: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 1:825 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-1625
Mailing Address - Country:US
Mailing Address - Phone:443-680-0371
Mailing Address - Fax:
Practice Address - Street 1:821 W HIGHWAY 50 STE 150
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1828
Practice Address - Country:US
Practice Address - Phone:618-726-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist