Provider Demographics
NPI:1548299142
Name:BAKER, JILL
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CALLE MACHO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3035
Mailing Address - Country:US
Mailing Address - Phone:949-492-7933
Mailing Address - Fax:949-492-8636
Practice Address - Street 1:410 CALLE MACHO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3035
Practice Address - Country:US
Practice Address - Phone:949-492-7933
Practice Address - Fax:949-492-8636
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT722AMedicare ID - Type UnspecifiedMEDICARE ID