Provider Demographics
NPI:1699463695
Name:BAKER, CASSIDY JOLYNN
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:JOLYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CLENEAY AVE APT 1139
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3591
Mailing Address - Country:US
Mailing Address - Phone:808-892-6089
Mailing Address - Fax:
Practice Address - Street 1:3800 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1035
Practice Address - Country:US
Practice Address - Phone:513-745-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer