Provider Demographics
NPI:1831113141
Name:BAKER, JILLEINE RUTH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JILLEINE
Middle Name:RUTH
Last Name:BAKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1665
Mailing Address - Country:US
Mailing Address - Phone:920-623-4914
Mailing Address - Fax:
Practice Address - Street 1:825 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1675
Practice Address - Country:US
Practice Address - Phone:920-623-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1121-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist