Provider Demographics
NPI:1104243401
Name:BAKER, ANGIE MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 N KY HIGHWAY 15 STE 1
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-5632
Mailing Address - Country:US
Mailing Address - Phone:606-439-3399
Mailing Address - Fax:606-487-9280
Practice Address - Street 1:3123 N KY HIGHWAY 15 STE 1
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-5632
Practice Address - Country:US
Practice Address - Phone:606-439-3399
Practice Address - Fax:606-487-9280
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-5082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist