Individual
MR. MICHAEL WALLACE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
5312 W 10TH ST, LITTLE ROCK, AR 72204-1852
(501) 280-9195
(501) 663-7267
Mailing address
67 KINGS HWY, CONWAY, AR 72032-9440
(501) 329-5416
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR1585
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTR1585
ARKANSAS STATE MEDICAL BOARD
AR
Enumeration date
09/19/2008
Last updated
09/19/2008
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