Provider Demographics
NPI:1346257938
Name:BALDWIN, TINA MARIE (OTR)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 OUTER CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9113
Mailing Address - Country:US
Mailing Address - Phone:502-836-0701
Mailing Address - Fax:
Practice Address - Street 1:2212 OUTER CIRCLE DR
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9113
Practice Address - Country:US
Practice Address - Phone:502-836-0701
Practice Address - Fax:502-243-9848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003152A225X00000X
KYKY-R2001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist