Provider Demographics
NPI:1760711345
Name:BAKER, STACY ANN (OT)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANN
Last Name:BAKER
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-1669
Mailing Address - Fax:314-514-3635
Practice Address - Street 1:14532 S OUTER 40 RD
Practice Address - Street 2:DEPT OCCUPATIONAL THERAPY, STE 120
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5705
Practice Address - Country:US
Practice Address - Phone:314-286-1669
Practice Address - Fax:314-514-3635
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009026788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO470052699Medicaid