Provider Demographics
NPI:1114312618
Name:BAKER, EMILY (OT/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3255
Mailing Address - Country:US
Mailing Address - Phone:740-357-2395
Mailing Address - Fax:
Practice Address - Street 1:522 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5505
Practice Address - Country:US
Practice Address - Phone:740-354-0270
Practice Address - Fax:740-354-0280
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.005541225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH25742134Medicaid