Provider Demographics
NPI:1386761963
Name:BAER, CYNTHIA DORRIS (OTR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DORRIS
Last Name:BAER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:CHILMARK
Mailing Address - State:MA
Mailing Address - Zip Code:02535-0442
Mailing Address - Country:US
Mailing Address - Phone:978-979-4500
Mailing Address - Fax:
Practice Address - Street 1:1900 LAFAYETTE RD
Practice Address - Street 2:SUITE C
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5679
Practice Address - Country:US
Practice Address - Phone:603-431-5600
Practice Address - Fax:603-431-5610
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH000039803OtherPTAN FOR GROUP PTAN RE776
NH30414644Medicaid