MEDICARE: MISS THERESA RITA BAKER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	011118	NY

General Provider Information

NPI Number	:	1295987063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS THERESA RITA BAKER OTR/L

Provider Business Mailing Address
First Line	:	55 MONROE BLVD
Second Line	:	5H
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4344
Country	:	US
Telephone Number	:	516-578-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 MONROE BLVD
Second Line	:	5H
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4344
Country	:	US
Telephone Number	:	516-578-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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