Provider Demographics
NPI:1568094738
Name:BAKNER, ERIKA (OT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BAKNER
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:PO BOX 5299
Mailing Address - Street 2:MS: 737-3-PCON
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415
Mailing Address - Country:US
Mailing Address - Phone:971-241-2804
Mailing Address - Fax:
Practice Address - Street 1:19321 MOUNTAIN HWY E # 100
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8450
Practice Address - Country:US
Practice Address - Phone:253-846-8618
Practice Address - Fax:253-846-8126
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61033110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist