Provider Demographics
NPI:1871123810
Name:BAKER, ELIZABETH KATHRYN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHRYN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6065
Mailing Address - Country:US
Mailing Address - Phone:315-297-9074
Mailing Address - Fax:
Practice Address - Street 1:57 W LAKE RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6065
Practice Address - Country:US
Practice Address - Phone:315-297-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13408225X00000X
NY023890225X00000X
MO2019037399225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist