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General NPI Number Information
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NPI Number | 1174246227
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Entity Type | Individual
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Provider Name | BAILEY BRANDT
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 6820 MADRONE DR
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City | ROCKFORD
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State | MI
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Zip | 49341-9578
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Country | US
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Telephone | 480-313-6777
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Fax | 855-810-1930
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Provider Business Mailing Address
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Address Line | 1707 W GREENLEAF AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60626-2419
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Country | US
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Telephone | 872-240-0668
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 222Q00000X
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License Number State |
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