Healthcare Provider Details

I. General information

NPI: 1629329917
Provider Name (Legal Business Name): MRS. REBECCA A BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 NE LANCASTER LN
LAWTON OK
73507-1924
US

IV. Provider business mailing address

3002 NE LANCASTER LN
LAWTON OK
73507-1924
US

V. Phone/Fax

Practice location:
  • Phone: 580-284-4592
  • Fax:
Mailing address:
  • Phone: 580-284-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: