Healthcare Provider Details

I. General information

NPI: 1689511628
Provider Name (Legal Business Name): BAILEY DEVANEY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MADISON AVE STE 320
MORRISTOWN NJ
07960-7337
US

IV. Provider business mailing address

19 HUTTON DR
MAHWAH NJ
07430-2984
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-4452
  • Fax:
Mailing address:
  • Phone: 973-971-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR01192000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: