Provider Demographics
NPI:1780035147
Name:BAKER, KATIE (MS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 RANDALL BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-8943
Mailing Address - Country:US
Mailing Address - Phone:239-216-6624
Mailing Address - Fax:
Practice Address - Street 1:4110 RANDALL BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-8943
Practice Address - Country:US
Practice Address - Phone:239-216-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other