Healthcare Provider Details

I. General information

NPI: 1285582445
Provider Name (Legal Business Name): MICAH LEE BAKER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 COBURG RD
EUGENE OR
97401-5477
US

IV. Provider business mailing address

81150 BEACH RD
CRESWELL OR
97426-9359
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-8041
  • Fax:
Mailing address:
  • Phone: 458-221-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10309
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: