Provider Demographics
NPI:1366973695
Name:BAKER, KARLA (OTR/L)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
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 1:3601 SW RIVER PKWY UNIT 1306
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4559
Mailing Address - Country:US
Mailing Address - Phone:757-618-2215
Mailing Address - Fax:
Practice Address - Street 1:3601 SW RIVER PKWY UNIT 1306
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4559
Practice Address - Country:US
Practice Address - Phone:757-618-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR337577225X00000X
VA0119006524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist