Provider Demographics
NPI:1093308660
Name:BAKER, VIVIENNE (OT)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2367 VALLEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1038
Mailing Address - Country:US
Mailing Address - Phone:619-209-0449
Mailing Address - Fax:
Practice Address - Street 1:9000 MURRAY DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3572
Practice Address - Country:US
Practice Address - Phone:619-209-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist