Healthcare Provider Details

I. General information

NPI: 1568029064
Provider Name (Legal Business Name): MRS. BAILEY CUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N STONE ST
DELAND FL
32720-0915
US

IV. Provider business mailing address

1466 WEST PKWY
DELAND FL
32724-3211
US

V. Phone/Fax

Practice location:
  • Phone: 386-473-6929
  • Fax:
Mailing address:
  • Phone: 386-473-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA17099
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: