MEDICARE: JO E BAILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222Q00000X	OTHER	IN	DEVELOPMENTAL THERAPY

General Provider Information

NPI Number	:	1205310695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO E BAILEY

Provider Business Mailing Address
First Line	:	46 E COUNTY ROAD 900 S
Second Line	:
City	:	OAKLAND CITY
State	:	IN
Zip	:	47660-9006
Country	:	US
Telephone Number	:	812-453-6430
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 E COUNTY ROAD 900 S
Second Line	:
City	:	OAKLAND CITY
State	:	IN
Zip	:	47660-9006
Country	:	US
Telephone Number	:	812-453-6430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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Directions to “ JO E BAILEY ” Practice Location

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