Provider Demographics
NPI:1285911925
Name:BAILEY, THERESA ANN (MS, OTR)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 EDGEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2116
Mailing Address - Country:US
Mailing Address - Phone:631-472-0384
Mailing Address - Fax:
Practice Address - Street 1:127 EDGEWATER AVE
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-2116
Practice Address - Country:US
Practice Address - Phone:631-472-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003863-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist