Provider Demographics
NPI:1386362820
Name:HEAD, BAYLI NICOLE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:BAYLI
Middle Name:NICOLE
Last Name:HEAD
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WALNUT STREET LOWER APARTMENT
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-9627
Mailing Address - Country:US
Mailing Address - Phone:585-689-5000
Mailing Address - Fax:
Practice Address - Street 1:2 TRIGON PARK
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1299
Practice Address - Country:US
Practice Address - Phone:585-768-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027024225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty