Provider Demographics
NPI:1316254451
Name:BAILEY, MARQUIS D (OT/L)
Entity type:Individual
Prefix:MR
First Name:MARQUIS
Middle Name:D
Last Name:BAILEY
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ALEXANDER PRESTON LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7294
Mailing Address - Country:US
Mailing Address - Phone:336-624-9345
Mailing Address - Fax:
Practice Address - Street 1:200 ALEXANDER PRESTON LN
Practice Address - Street 2:
Practice Address - City:WINSTON - SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127
Practice Address - Country:US
Practice Address - Phone:336-624-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist