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General NPI Number Information
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NPI Number | 1043872633
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Entity Type | Individual
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Provider Name | BAILEY R TERPSTRA LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 1229 C AVE E
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City | OSKALOOSA
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State | IA
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Zip | 52577-4246
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Country | US
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Telephone | 641-672-3274
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Fax | 641-672-2702
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Provider Business Mailing Address
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Address Line | PO BOX 254
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City | LYNNVILLE
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State | IA
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Zip | 50153-0254
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Country | US
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Telephone | 641-891-5320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001218
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License Number State | IA
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