Healthcare Provider Details

I. General information

NPI: 1083878573
Provider Name (Legal Business Name): EVE JUDITH BAKER L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 COTTON MILL HL B-103
BRATTLEBORO VT
05301-7170
US

IV. Provider business mailing address

68 OVERLOOK DR
BRATTLEBORO VT
05301-4301
US

V. Phone/Fax

Practice location:
  • Phone: 802-251-6059
  • Fax:
Mailing address:
  • Phone: 802-251-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0146917-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26BT00010300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: