Healthcare Provider Details

I. General information

NPI: 1164132379
Provider Name (Legal Business Name): JASMIN SIERRA BAILEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SPRING ST
STREATOR IL
61364-3332
US

IV. Provider business mailing address

615 MAGNOLIA LN
OTTAWA IL
61350-4154
US

V. Phone/Fax

Practice location:
  • Phone: 815-673-4683
  • Fax:
Mailing address:
  • Phone: 815-768-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number070026895
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: