Provider Demographics
NPI:1609198332
Name:BACCARAT, VANESSA GALE (OTR)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:GALE
Last Name:BACCARAT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 KURTH ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2724
Mailing Address - Country:US
Mailing Address - Phone:503-570-3665
Mailing Address - Fax:503-570-9155
Practice Address - Street 1:4120 KURTH ST S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2724
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:503-570-9155
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist