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NPI Code Detail

MEDICARE: MS. SUSAN LYNN BAKER B.S., PTA, OTR

MEDICARE: MS. SUSAN LYNN BAKER B.S., PTA, OTR
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
1225X00000XOccupational Therapist310011424AIN
2225XP0200XPediatric Occupational Therapist
3225X00000XOccupational Therapist31001142AIN

General Provider Information

NPI Number : 1194836072
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN LYNN BAKER B.S., PTA, OTR
Provider Business Mailing Address
First Line : 4740 KINGSWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-1521
Country : US
Telephone Number : 317-466-2001
Fax Number : 317-466-2000
Provider Business Practice Location Address
First Line : 4740 KINGSWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-1521
Country : US
Telephone Number : 317-466-2001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 09/25/2019

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