=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598387482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA MAE BAKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2020
-----------------------------------------------------
Last Update Date | 05/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 FRAM ST.
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-772-4291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1111
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99833-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-244-3956
-----------------------------------------------------
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 | 146186
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------