Provider Demographics
NPI:1386253037
Name:LANDRY, BAILY AMEDEE (MOT)
Entity type:Individual
Prefix:
First Name:BAILY
Middle Name:AMEDEE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:BAILY
Other - Middle Name:ELISE
Other - Last Name:AMEDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8080 BLUEBONNET BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7827
Mailing Address - Country:US
Mailing Address - Phone:225-924-2424
Mailing Address - Fax:225-408-7980
Practice Address - Street 1:1014 SAINT CLAIR BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5027
Practice Address - Country:US
Practice Address - Phone:225-215-4437
Practice Address - Fax:225-390-1419
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324054225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist