Provider Demographics
NPI:1174392849
Name:BAKER, ABBY JOAN (MOT, OTL)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:JOAN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MOT, OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 MIDVALE CIR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4219
Mailing Address - Country:US
Mailing Address - Phone:319-215-2972
Mailing Address - Fax:
Practice Address - Street 1:2020 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1426
Practice Address - Country:US
Practice Address - Phone:404-367-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005514225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist