Healthcare Provider Details

I. General information

NPI: 1477280709
Provider Name (Legal Business Name): BAYLEE PHELPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 E MERIDIAN PARK LOOP STE C
WASILLA AK
99654-7233
US

IV. Provider business mailing address

3331 W SAKAI ST
WASILLA AK
99654-0777
US

V. Phone/Fax

Practice location:
  • Phone: 907-864-0099
  • Fax:
Mailing address:
  • Phone: 907-232-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number198016
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: