Basic Information
| Provider Information | |||||||||
| NPI: | 1255367256 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUER-LARSON | ||||||||
| FirstName: | GERMAINE | ||||||||
| MiddleName: | BARBARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557465109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182631000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 E 37TH ST STE 20 | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557462972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184401548 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 100005 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 08R87BA | 01 | MN | BCBS | OTHER |