Provider Demographics
NPI:1932590098
Name:BAKER, CAROL A (SHIATSU CP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:SHIATSU CP
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SHIATSU CP
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:VINALHAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04863-0122
Mailing Address - Country:US
Mailing Address - Phone:617-388-7460
Mailing Address - Fax:
Practice Address - Street 1:16 CLAYTER HILL RD
Practice Address - Street 2:
Practice Address - City:VINALHAVEN
Practice Address - State:ME
Practice Address - Zip Code:04863-0122
Practice Address - Country:US
Practice Address - Phone:617-388-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist