Provider Demographics
NPI:1619622776
Name:BAKER, NICOLE LAYNE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAYNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SEIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:253 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-9658
Mailing Address - Country:US
Mailing Address - Phone:360-749-7497
Mailing Address - Fax:
Practice Address - Street 1:200 TRIANGLE SHOPPING CTR STE 270
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4684
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist