Provider Demographics
NPI:1629212568
Name:BAKER, PAULA KAY
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:KAY
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:KAY
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:349 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402
Mailing Address - Country:US
Mailing Address - Phone:937-461-3504
Mailing Address - Fax:937-461-9584
Practice Address - Street 1:349 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402
Practice Address - Country:US
Practice Address - Phone:937-461-3504
Practice Address - Fax:937-461-9584
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist