Provider Demographics
NPI:1356664320
Name:BAKER, DEVINA JO
Entity Type:Individual
Prefix:MISS
First Name:DEVINA
Middle Name:JO
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 1:796 LEVI BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SMILAX
Mailing Address - State:KY
Mailing Address - Zip Code:41764-8996
Mailing Address - Country:US
Mailing Address - Phone:606-279-7704
Mailing Address - Fax:
Practice Address - Street 1:796 LEVI BRANCH RD
Practice Address - Street 2:
Practice Address - City:SMILAX
Practice Address - State:KY
Practice Address - Zip Code:41764-8996
Practice Address - Country:US
Practice Address - Phone:606-279-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist