Healthcare Provider Details

I. General information

NPI: 1194682120
Provider Name (Legal Business Name): BAILEY SIEGRIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 STATE ROUTE Z
WILLOW SPRINGS MO
65793-9163
US

IV. Provider business mailing address

1254 STATE ROUTE Z
WILLOW SPRINGS MO
65793-9163
US

V. Phone/Fax

Practice location:
  • Phone: 417-252-0554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2024014947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: