Provider Demographics
NPI:1972177392
Name:BAKER, ANGELA (OTD, PHD, MA,OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:OTD, PHD, MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:SKYFOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92385-0735
Mailing Address - Country:US
Mailing Address - Phone:626-826-4049
Mailing Address - Fax:
Practice Address - Street 1:28476 LARCHMONT LANE
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92385
Practice Address - Country:US
Practice Address - Phone:626-826-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4968225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics