Healthcare Provider Details

I. General information

NPI: 1104597814
Provider Name (Legal Business Name): ASHTEN MIKAELA BAILEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 US-98 100A
PORT ST JOE FL
32456
US

IV. Provider business mailing address

3844 HIGHWAY 22
WEWAHITCHKA FL
32465-2429
US

V. Phone/Fax

Practice location:
  • Phone: 850-229-5752
  • Fax: 850-229-5753
Mailing address:
  • Phone: 850-340-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA18487
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: