Provider Demographics
NPI:1801379565
Name:BAKER, KAILEY ALEXANDRA (AT-C, OT-C)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:ALEXANDRA
Last Name:BAKER
Suffix:
Gender:F
Credentials:AT-C, OT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 NE 85TH PL APT 2A-101
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6644
Mailing Address - Country:US
Mailing Address - Phone:434-851-1213
Mailing Address - Fax:
Practice Address - Street 1:510 8TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-5436
Practice Address - Country:US
Practice Address - Phone:425-392-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAATHL.A1.608751682255A2300X
WA18-0416207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer