Provider Demographics
NPI:1538802269
Name:BAKER, CELINE (COTA/L)
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 CAPITAL CIR NE STE 106
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1115
Mailing Address - Country:US
Mailing Address - Phone:850-725-5008
Mailing Address - Fax:
Practice Address - Street 1:2743 CAPITAL CIR NE STE 106
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-1115
Practice Address - Country:US
Practice Address - Phone:850-725-5008
Practice Address - Fax:850-383-0099
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty