Provider Demographics
NPI:1871679233
Name:BAKER, JENNIFER MICHELLE (OTD, OTR/L, BCP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:OTD, OTR/L, BCP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 WATKINS PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7643
Mailing Address - Country:US
Mailing Address - Phone:386-585-5955
Mailing Address - Fax:386-585-7017
Practice Address - Street 1:15 CYPRESS BRANCH WAY STE 207D
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8414
Practice Address - Country:US
Practice Address - Phone:386-585-5955
Practice Address - Fax:386-585-7017
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2967225X00000X
FLOT14766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist