MEDICARE: TENEISHA 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1437577277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENEISHA BAKER

Provider Business Mailing Address
First Line	:	7421 NW 107TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-4461
Country	:	US
Telephone Number	:	405-314-5984
Fax Number	:

Provider Business Practice Location Address
First Line	:	7421 NW 107TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-4461
Country	:	US
Telephone Number	:	405-314-5984
Fax Number	:

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

Provider Enumeration Date	:	03/30/2014
Last Update Date	:	03/30/2014

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Directions to “ TENEISHA BAKER ” Practice Location

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