Provider Demographics
NPI:1356619563
Name:BAER, CAROLYNN T (OTR)
Entity type:Individual
Prefix:MS
First Name:CAROLYNN
Middle Name:T
Last Name:BAER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 MARSHALL HALL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3718
Mailing Address - Country:US
Mailing Address - Phone:703-378-2059
Mailing Address - Fax:
Practice Address - Street 1:4605 MARSHALL HALL LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3718
Practice Address - Country:US
Practice Address - Phone:703-378-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist