Individual
MICHELLE LYNN BAUMEISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
25250 75TH ST, PADDOCK LAKE, WI 53168
(262) 843-4200
(262) 843-4578
Mailing address
3601 30TH AVE, STE 103, KENOSHA, WI 53144
(262) 657-0222
(262) 657-7190
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3629
WI
225100000X
Physical Therapist
056006611
IL
225100000X
Physical Therapist
3629026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0604410001
DMERC
WI
05
—
40836800
—
WI
01
—
P00073608
RAILROAD MEDICARE NUMBER
WI
Enumeration date
07/03/2006
Last updated
12/04/2017
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