Healthcare Provider Details

I. General information

NPI: 1295798395
Provider Name (Legal Business Name): LAURA L BAKER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 WILLAKENZIE RD
EUGENE OR
97401-4871
US

IV. Provider business mailing address

95 MERRY LN
EUGENE OR
97404-2678
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-3174
  • Fax: 541-687-3684
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-806534
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: