Provider Demographics
NPI:1700115193
Name:BAKER, KIMBERLY REENEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:REENEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-4341
Mailing Address - Country:US
Mailing Address - Phone:207-495-2693
Mailing Address - Fax:
Practice Address - Street 1:158 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6027
Practice Address - Country:US
Practice Address - Phone:207-786-0691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA2315224Z00000X
IN32001741A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant