Basic Information
| Provider Information | |||||||||
| NPI: | 1346846359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAISDEN | ||||||||
| FirstName: | AUTUMN | ||||||||
| MiddleName: | KIMBERLEE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WILLIAMSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415034072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062371700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH WILLIAMSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415034072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062371700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2020 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 260970 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.