Provider Demographics
NPI:1528250743
Name:BAEK, CARROL YOONJUNG (OTR/L)
Entity type:Individual
Prefix:MS
First Name:CARROL
Middle Name:YOONJUNG
Last Name:BAEK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25661 HURON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3702
Mailing Address - Country:US
Mailing Address - Phone:909-796-2978
Mailing Address - Fax:
Practice Address - Street 1:25661 HURON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3702
Practice Address - Country:US
Practice Address - Phone:909-796-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist