Provider Demographics
NPI:1053409011
Name:BAKER, SHELLEY S (OTR/L)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:S
Last Name:BAKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:SIKES
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3915 W 90TH TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2329
Mailing Address - Country:US
Mailing Address - Phone:913-381-1326
Mailing Address - Fax:913-381-2673
Practice Address - Street 1:7501 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-2103
Practice Address - Country:US
Practice Address - Phone:816-421-5848
Practice Address - Fax:816-237-2065
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000017225X00000X
KS17-00419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist