Individual
MR. KENNETH EARL BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC/R
Contact information
Practice address
2835 NE DESTINY DR, MCMINNVILLE, OR 97128-8885
(503) 476-4321
Mailing address
2835 NE DESTINY DR, MCMINNVILLE, OR 97128-8885
(503) 476-4321
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-746539
OR
Other
Enumeration date
11/17/2005
Last updated
07/26/2016
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