Provider Demographics
NPI:1801155932
Name:BAUE-SCOTT, ANDREA LYNN (LMP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:BAUE-SCOTT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17202 NE 85TH PL
Mailing Address - Street 2:APT. M226
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6638
Mailing Address - Country:US
Mailing Address - Phone:206-724-2729
Mailing Address - Fax:
Practice Address - Street 1:17202 NE 85TH PL
Practice Address - Street 2:APT. M226
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6638
Practice Address - Country:US
Practice Address - Phone:206-724-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60284741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist