Provider Demographics
NPI:1194100388
Name:BAKER, JORDAN (OT-R)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:OT-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 NORDIC DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2836
Mailing Address - Country:US
Mailing Address - Phone:502-572-0880
Mailing Address - Fax:
Practice Address - Street 1:700 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3082
Practice Address - Country:US
Practice Address - Phone:812-288-4688
Practice Address - Fax:812-610-8333
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31005890A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist