Provider Demographics
NPI:1235939331
Name:BAKER, JEREMY JAMES
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JAMES
Last Name:BAKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PORCUPINE CIR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4829
Mailing Address - Country:US
Mailing Address - Phone:603-386-1796
Mailing Address - Fax:
Practice Address - Street 1:142 PORCUPINE CIR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4829
Practice Address - Country:US
Practice Address - Phone:603-386-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist