Provider Demographics
NPI:1588909113
Name:BAXTER, JOHN PHILLIP (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PHILLIP
Last Name:BAXTER
Suffix:
Gender:M
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 1:25 CARMEL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1790
Mailing Address - Country:US
Mailing Address - Phone:203-421-7087
Mailing Address - Fax:
Practice Address - Street 1:25 CARMEL CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-1790
Practice Address - Country:US
Practice Address - Phone:203-421-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000266225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist