Healthcare Provider Details

I. General information

NPI: 1982676425
Provider Name (Legal Business Name): ANNIKA BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CONVOCATION CENTER OHIO UNIVERSITY
ATHENS OH
45701-2979
US

IV. Provider business mailing address

45850 POMEROY PIKE
RACINE OH
45771-9545
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-1206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 002556
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: