Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | KY-R3387 | KY |
NPI | 1003015645 |
---|---|
Provider Name | Mrs. Stacy Michelle Baker |
First Address | Corydon, KY 42406-9765 |
Second Address | Morganfield, KY 42437-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12500765 | (05) | KY |