Provider Demographics
NPI:1396196788
Name:GAJIC-BAKIC, TEODORA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:TEODORA
Middle Name:
Last Name:GAJIC-BAKIC
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3701
Mailing Address - Country:US
Mailing Address - Phone:267-918-2851
Mailing Address - Fax:
Practice Address - Street 1:395 BISHOP HOLLOW RD UNIT H
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3233
Practice Address - Country:US
Practice Address - Phone:610-356-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011459225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist