Provider Demographics
NPI:1811202997
Name:BAKER, KEILA M (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KEILA
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16844 EASY ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7814
Mailing Address - Country:US
Mailing Address - Phone:907-350-4395
Mailing Address - Fax:907-694-5524
Practice Address - Street 1:16844 EASY ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7814
Practice Address - Country:US
Practice Address - Phone:907-350-4395
Practice Address - Fax:907-694-5524
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist