MEDICARE: MRS. JILL 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	225X00000X	Occupational Therapist	OT722	CA

General Provider Information

NPI Number	:	1548299142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL BAKER

Provider Business Mailing Address
First Line	:	410 CALLE MACHO
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-3035
Country	:	US
Telephone Number	:	949-492-7933
Fax Number	:	949-492-8636

Provider Business Practice Location Address
First Line	:	410 CALLE MACHO
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-3035
Country	:	US
Telephone Number	:	949-492-7933
Fax Number	:	949-492-8636

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/21/2008

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