Provider Demographics
NPI:1447482013
Name:BAIR, NANCY (MT-BC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BAIR
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15705 NW HACKNEY DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8991
Mailing Address - Country:US
Mailing Address - Phone:503-614-0410
Mailing Address - Fax:
Practice Address - Street 1:15705 NW HACKNEY DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8991
Practice Address - Country:US
Practice Address - Phone:503-614-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist