Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1053714253 |
---|---|
Provider Name | Elizabeth Baker |
First Address | Susanville, CA 96130-4808 |
Second Address | Susanville, CA 96130-4808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2014 |
Last Update Date | 01/10/2014 |