=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174686075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER A BAKER MS,OTR-L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 09/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 W MAIN ST
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13838-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-563-2135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 197 PAT FARLEY RD
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13815-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-334-9826
-----------------------------------------------------
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 | 013302-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------