Provider Demographics
NPI:1194766626
Name:BAUER, CONSTANCE ANN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANN
Last Name:BAUER
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 1:19215 HOULE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59834-9610
Mailing Address - Country:US
Mailing Address - Phone:406-370-6758
Mailing Address - Fax:406-626-4659
Practice Address - Street 1:19215 HOULE CREEK RD
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834-9610
Practice Address - Country:US
Practice Address - Phone:406-370-6758
Practice Address - Fax:406-626-4659
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0601868OtherMEDICAID WAIVER
MT000662660OtherBLUE CROSS BLUE SHIELD
MT3402178Medicaid
MT3402178Medicaid