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General NPI Number Information
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NPI Number | 1336342666
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Entity Type | Individual
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Provider Name | GARY BAKER OTRL
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6135 ROOSEVELT HWY
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City | WARM SPRINGS
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State | GA
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Zip | 31830
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Country | US
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Telephone | 706-655-5636
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Fax |
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Provider Business Mailing Address
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Address Line | 71 VIRGINIA AVE
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City | SHARPSBURG
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State | GA
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Zip | 30277
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT003933
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License Number State | GA
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