Provider Demographics
NPI:1780154591
Name:BAKER, AMANDA BROOKE I (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:BAKER
Suffix:I
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-2127
Mailing Address - Country:US
Mailing Address - Phone:423-443-0727
Mailing Address - Fax:
Practice Address - Street 1:1607 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-2127
Practice Address - Country:US
Practice Address - Phone:423-443-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4710225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4710OtherSTATE OF TENNESSEE