Provider Demographics
NPI:1992739403
Name:BAIRD-KNICKERBOCKER, KAREN (OT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:BAIRD-KNICKERBOCKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N CALIFORNIA STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801
Mailing Address - Country:US
Mailing Address - Phone:575-838-1000
Mailing Address - Fax:575-838-2000
Practice Address - Street 1:911 N CALIFORNIA STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801
Practice Address - Country:US
Practice Address - Phone:505-838-1000
Practice Address - Fax:505-838-2000
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM345629602Medicare PIN