Healthcare Provider Details

I. General information

NPI: 1770127177
Provider Name (Legal Business Name): BETHANY BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 OLD GEORGETOWN RD
BETHESDA MD
20814-1745
US

IV. Provider business mailing address

2120 VERMONT AVE NW APT 208
WASHINGTON DC
20001-4054
US

V. Phone/Fax

Practice location:
  • Phone: 716-969-0333
  • Fax:
Mailing address:
  • Phone: 716-969-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT210002028
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119-009430
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number09581
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: