Provider Demographics
NPI:1548442775
Name:BAKER, SAMANTHA RAE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:RAE
Last Name:BAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:248 STATE ST
Mailing Address - Street 2:TWIN CITY PLAZA
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1519
Mailing Address - Country:US
Mailing Address - Phone:207-989-2034
Mailing Address - Fax:207-989-5971
Practice Address - Street 1:248 STATE STREET
Practice Address - Street 2:TWIN CITY PLAZA
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-989-2034
Practice Address - Fax:207-989-5971
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA1615224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant