Provider Demographics
NPI:1104597814
Name:BAILEY, ASHTEN MIKAELA (OTR/L)
Entity type:Individual
Prefix:
First Name:ASHTEN
Middle Name:MIKAELA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-2441
Mailing Address - Country:US
Mailing Address - Phone:850-340-3550
Mailing Address - Fax:
Practice Address - Street 1:301 W 26TH ST
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4713
Practice Address - Country:US
Practice Address - Phone:850-769-5371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26522225X00000X
FLOTA18487224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant