Healthcare Provider Details

I. General information

NPI: 1821719386
Provider Name (Legal Business Name): BAILEY READY MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 W BRUNDAGE LN
SHERIDAN WY
82801-5827
US

IV. Provider business mailing address

PO BOX 318
EKALAKA MT
59324-0318
US

V. Phone/Fax

Practice location:
  • Phone: 307-673-4420
  • Fax:
Mailing address:
  • Phone: 406-853-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1441
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: