Healthcare Provider Details

I. General information

NPI: 1003480609
Provider Name (Legal Business Name): NICHOLETTE NOEL BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date: 01/24/2025
Reactivation Date: 02/04/2025

III. Provider practice location address

2600 COMPASS RD
GLENVIEW IL
60026-8001
US

IV. Provider business mailing address

51145 NICOLETTE DR
CHESTERFIELD MI
48047-4585
US

V. Phone/Fax

Practice location:
  • Phone: 877-787-3430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201014092
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: