Healthcare Provider Details

I. General information

NPI: 1386099349
Provider Name (Legal Business Name): RASHAUN BAILEY ATC, NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 11/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8655 MARKET ST
MENTOR OH
44060-4170
US

IV. Provider business mailing address

14240 RYAN DR
WALTON HILLS OH
44146-4181
US

V. Phone/Fax

Practice location:
  • Phone: 216-647-8771
  • Fax:
Mailing address:
  • Phone: 216-647-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number183551
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT0797
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: