Provider Demographics
NPI:1164795100
Name:BAKER, MICHELLE LENEE (OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LENEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LENEE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3609 BOND ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3801
Mailing Address - Country:US
Mailing Address - Phone:919-231-8113
Mailing Address - Fax:919-231-8113
Practice Address - Street 1:3609 BOND ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3801
Practice Address - Country:US
Practice Address - Phone:919-231-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist