Healthcare Provider Details

I. General information

NPI: 1013553429
Provider Name (Legal Business Name): SIDNEY J BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIDNEY DREW

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW MURRAY RD
LEES SUMMIT MO
64081-1425
US

IV. Provider business mailing address

22120 MIDLAND DR STE 1
SHAWNEE KS
66226-3554
US

V. Phone/Fax

Practice location:
  • Phone: 816-944-4244
  • Fax: 816-944-4245
Mailing address:
  • Phone: 913-745-4064
  • Fax: 913-745-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2019041710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: