=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073778718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. MARY E BAKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2008
-----------------------------------------------------
Last Update Date | 07/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1419 ESSINGTON RD
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-729-2160
-----------------------------------------------------
Fax | 815-729-2958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2677 BLUESTONE BAY DR
-----------------------------------------------------
City | NEW LENOX
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-485-7234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 056008306
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------