Provider Demographics
NPI:1891081949
Name:BAILEY, MELODY JEAN (COTA)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:JEAN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8570 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1911
Mailing Address - Country:US
Mailing Address - Phone:714-585-6412
Mailing Address - Fax:
Practice Address - Street 1:8570 EDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1911
Practice Address - Country:US
Practice Address - Phone:714-585-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1553174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator