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General NPI Number Information
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NPI Number | 1992739403
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Entity Type | Individual
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Provider Name | KAREN BAIRD-KNICKERBOCKER OT
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 911 N CALIFORNIA STREET SUITE B
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City | SOCORRO
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State | NM
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Zip | 87801
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Country | US
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Telephone | 505-838-1000
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Fax | 505-838-2000
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Provider Business Mailing Address
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Address Line | 911 N CALIFORNIA STREET SUITE B
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City | SOCORRO
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State | NM
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Zip | 87801
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Country | US
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Telephone | 575-838-1000
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Fax | 575-838-2000
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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 | 2067
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License Number State | NM
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