1871679233 NPI number — JENNIFER MICHELLE BAKER OTD, OTR/L, BCP

NPI Number: 1871679233
Health Care Provider/Practitioner: JENNIFER MICHELLE BAKER OTD, OTR/L, BCP

NPI Number : 1871679233 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871679233",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BAKER",
    "FirstName": "JENNIFER",
    "MiddleName": "MICHELLE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "OTD, OTR/L, BCP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NICHOLAS",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10 WATKINS PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALM COAST",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32164-7643",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "386-585-5955",
    "MailingAddressFaxNumber": "386-585-7017",
    "FirstLinePracticeLocationAddress": "15 CYPRESS BRANCH WAY STE 207D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PALM COAST",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32164-8414",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-585-5955",
    "PracticeLocationAddressFaxNumber": "386-585-7017",
    "EnumerationDate": "10/28/2006",
    "LastUpdateDate": "05/01/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "2967",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "OT14766",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}