Provider Demographics
NPI:1386375400
Name:BAILEY, CARSON ELISE (COTA/L)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:ELISE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:ELISE
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-3206
Mailing Address - Country:US
Mailing Address - Phone:731-499-0295
Mailing Address - Fax:
Practice Address - Street 1:14510 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-7824
Practice Address - Country:US
Practice Address - Phone:731-352-5317
Practice Address - Fax:731-352-5942
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3826224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant