Provider Demographics
NPI:1245379825
Name:BAXTER, GRETA BRAUNER (OT)
Entity type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:BRAUNER
Last Name:BAXTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 CAPE COD CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4302
Mailing Address - Country:US
Mailing Address - Phone:502-366-4100
Mailing Address - Fax:502-253-4599
Practice Address - Street 1:2520 BARDSTOWN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2685
Practice Address - Country:US
Practice Address - Phone:502-451-2142
Practice Address - Fax:502-451-2740
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1463OtherCBIS PROVIDER NUMBER