Provider Demographics
NPI:1083907984
Name:BAKER, TOSHA MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:TOSHA
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TOSHA
Other - Middle Name:MARIE
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:10101 MADDOX LN
Mailing Address - Street 2:E 102
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7641
Mailing Address - Country:US
Mailing Address - Phone:618-925-6092
Mailing Address - Fax:
Practice Address - Street 1:26850 S BAY DR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4379
Practice Address - Country:US
Practice Address - Phone:239-948-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10267320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities