Provider Demographics
NPI:1457501140
Name:BAKER, SUZANNE KATHLEEN (OT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KATHLEEN
Last Name:BAKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9440
Mailing Address - Country:US
Mailing Address - Phone:501-329-5416
Mailing Address - Fax:
Practice Address - Street 1:5312 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1852
Practice Address - Country:US
Practice Address - Phone:501-280-9195
Practice Address - Fax:501-663-7261
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR356225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROTR356OtherARKANSAS STATER MEDICAL BOARD