MEDICARE: ERICA DAWN BAKER

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	222Q00000X	Developmental Therapist	200701966	KY

General Provider Information

NPI Number	:	1114169752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA DAWN BAKER

Provider Business Mailing Address
First Line	:	1662 FOXHAVEN DR APT 12
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-1085
Country	:	US
Telephone Number	:	606-269-1818
Fax Number	:	859-623-8578

Provider Business Practice Location Address
First Line	:	1662 FOXHAVEN DR APT 12
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-1085
Country	:	US
Telephone Number	:	606-269-1818
Fax Number	:	859-623-8578

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

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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