Basic Information
| Provider Information | |||||||||
| NPI: | 1801379565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | KAILEY | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
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| Credential: | AT-C, OT-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17325 NE 85TH PL APT 2A-101 | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980526644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348511213 | ||||||||
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| Practice Location | |||||||||
| Address1: | 510 8TH AVE NE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980295436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253923030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2018 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | ATHL.A1.60875168 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 207X00000X | 18-0416 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.