Provider Demographics
NPI:1114169752
Name:BAKER, ERICA DAWN
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DAWN
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 FOXHAVEN DR APT 12
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1085
Mailing Address - Country:US
Mailing Address - Phone:606-269-1818
Mailing Address - Fax:859-623-8578
Practice Address - Street 1:1662 FOXHAVEN DR APT 12
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1085
Practice Address - Country:US
Practice Address - Phone:606-269-1818
Practice Address - Fax:859-623-8578
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200701966222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist