Healthcare Provider Details

I. General information

NPI: 1275281149
Provider Name (Legal Business Name): RACHEL BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 11/27/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 VOLUNTEER AVE
CLINTWOOD VA
24228-9400
US

IV. Provider business mailing address

295 JAYNE HILL CIR
GATE CITY VA
24251-2439
US

V. Phone/Fax

Practice location:
  • Phone: 276-926-4643
  • Fax:
Mailing address:
  • Phone: 276-708-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119-009324
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: