Provider Demographics
NPI:1841569423
Name:BAISH, LOUIS JOSEPH JR (OTR)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:JOSEPH
Last Name:BAISH
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROSLYN DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9744
Mailing Address - Country:US
Mailing Address - Phone:518-399-3215
Mailing Address - Fax:
Practice Address - Street 1:13 ROSLYN DR
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-9744
Practice Address - Country:US
Practice Address - Phone:518-399-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003962-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist