Healthcare Provider Details

I. General information

NPI: 1275374225
Provider Name (Legal Business Name): BAILEE MARIE COSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E PERRY ST
TIFFIN OH
44883-2310
US

IV. Provider business mailing address

111 E PERRY ST
TIFFIN OH
44883-2310
US

V. Phone/Fax

Practice location:
  • Phone: 419-618-4753
  • Fax:
Mailing address:
  • Phone: 419-618-4753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberUU860129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: