MEDICARE: KELSEY A. BAKER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC012195	PA

General Provider Information

NPI Number	:	1033482070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY A. BAKER OTR/L

Provider Business Mailing Address
First Line	:	2213 E CUMBERLAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2203
Country	:	US
Telephone Number	:	607-592-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 E CUMBERLAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2203
Country	:	US
Telephone Number	:	607-592-5283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	07/11/2022

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