Individual
ETHAN BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3801 JOHNSON MILL BLVD, FAYETTEVILLE, AR 72704-5297
(479) 856-6400
Mailing address
3801 JOHNSON MILL BLVD, FAYETTEVILLE, AR 72704-5297
(479) 856-6400
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A994
AR
Other
Enumeration date
08/10/2015
Last updated
08/10/2015
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