Healthcare Provider Details

I. General information

NPI: 1316850233
Provider Name (Legal Business Name): BAILEE BRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 KING ST
COCOA FL
32922-7621
US

IV. Provider business mailing address

5035 MARKET ST
COCOA FL
32927-9225
US

V. Phone/Fax

Practice location:
  • Phone: 321-349-9379
  • Fax: 321-208-7441
Mailing address:
  • Phone: 321-349-9379
  • Fax: 321-208-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2850851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: