Provider Demographics
NPI:1205607363
Name:BAKER, TANISHA K (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:K
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 1:18 MORSE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7035
Mailing Address - Country:US
Mailing Address - Phone:401-649-5098
Mailing Address - Fax:
Practice Address - Street 1:18 MORSE AVE APT 4
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7035
Practice Address - Country:US
Practice Address - Phone:401-649-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist