Healthcare Provider Details

I. General information

NPI: 1871807313
Provider Name (Legal Business Name): PATRICK BYRON BAILEY C.O.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 N 67TH AVE
GLENDALE AZ
85302-4308
US

IV. Provider business mailing address

15231 W POST DR
SURPRISE AZ
85374-1424
US

V. Phone/Fax

Practice location:
  • Phone: 623-939-9475
  • Fax:
Mailing address:
  • Phone: 623-466-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3365
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: