MEDICARE: MS. CARLA D BAKER ATC

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	174400000X	Specialist	370	NM

General Provider Information

NPI Number	:	1114991031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA D BAKER ATC

Provider Business Mailing Address
First Line	:	2720 TOPLEY AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1334
Country	:	US
Telephone Number	:	505-522-5327
Fax Number	:	505-521-3668

Provider Business Practice Location Address
First Line	:	1181 MALL DR STE D
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8191
Country	:	US
Telephone Number	:	505-522-5327
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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