Provider Demographics
NPI:1174686075
Name:BAKER, HEATHER A (MS,OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS,OTR-L
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:SHAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR-L
Mailing Address - Street 1:197 PAT FARLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3124
Mailing Address - Country:US
Mailing Address - Phone:607-334-9826
Mailing Address - Fax:
Practice Address - Street 1:95 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1601
Practice Address - Country:US
Practice Address - Phone:607-563-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013302-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist