Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 10246 | NC |
NPI | 1811650393 |
---|---|
Provider Name | Kimberly Baker |
First Address | Fremont, NC 27830-9116 |
Second Address | Fremont, NC 27830-9116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2021 |
Last Update Date | 20/10/2021 |