Healthcare Provider Details

I. General information

NPI: 1881245066
Provider Name (Legal Business Name): JAILVA BAILEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 HIGH AVE
MOUNTAIN HOME AR
72653-5340
US

IV. Provider business mailing address

244 WALLICK DR
COTTER AR
72626-9782
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-2478
  • Fax:
Mailing address:
  • Phone: 870-421-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4835
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: