Provider Demographics
NPI:1588752075
Name:BAYLISS, LEAH A (OT)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:A
Last Name:BAYLISS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WILDBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-9221
Mailing Address - Country:US
Mailing Address - Phone:601-939-3510
Mailing Address - Fax:
Practice Address - Street 1:521 PELAHATCHIE SHORE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6282
Practice Address - Country:US
Practice Address - Phone:601-613-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist