1669566998 NPI number — MRS. CASEY JEAN HOOVER BAKER OTR/L, CHT

Table of content: MRS. CASEY JEAN HOOVER BAKER OTR/L, CHT (NPI 1669566998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669566998 NPI number — MRS. CASEY JEAN HOOVER BAKER OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
CASEY
Provider Middle Name:
JEAN HOOVER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOOVER
Provider Other First Name:
CASEY
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L, CHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669566998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 SANFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-2573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-437-0888
Provider Business Mailing Address Fax Number:
828-437-1020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 SANFORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-2573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-437-0888
Provider Business Practice Location Address Fax Number:
828-437-1020
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT10116 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 6830 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 727556 . This is a "OPTUMHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7302121 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150RY . This is a "BLUECROSS BLUESHIELD OF NORTH CAROLINA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 890147300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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