Healthcare Provider Details

I. General information

NPI: 1518636166
Provider Name (Legal Business Name): ALICIA ELLEN BAILEY MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 ANDOVER RD
WESTBROOK ME
04092-3850
US

IV. Provider business mailing address

123 ANDOVER RD
WESTBROOK ME
04092-3850
US

V. Phone/Fax

Practice location:
  • Phone: 207-661-6214
  • Fax:
Mailing address:
  • Phone: 207-661-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberOT4169
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: