Healthcare Provider Details

I. General information

NPI: 1912583303
Provider Name (Legal Business Name): BAILEY ROSE BOC CPED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 BOB WALLACE AVE SW STE B
HUNTSVILLE AL
35805-4166
US

IV. Provider business mailing address

2905 BOB WALLACE AVE SW STE B
HUNTSVILLE AL
35805-4166
US

V. Phone/Fax

Practice location:
  • Phone: 256-203-2647
  • Fax:
Mailing address:
  • Phone: 256-203-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: