Healthcare Provider Details

I. General information

NPI: 1639763907
Provider Name (Legal Business Name): BAILEY GRAGG MITCHELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BAILEY LAUREL GRAGG

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N CENTER ST
HICKORY NC
28601-1853
US

IV. Provider business mailing address

122 WHISPERING PINE ST
MORGANTON NC
28655-8281
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-7826
  • Fax:
Mailing address:
  • Phone: 828-448-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number13073
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13073
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: