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General NPI Number Information
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NPI Number | 1194846451
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Entity Type | Individual
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Provider Name | NICOLE DAWN BAILEY OTR
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 505 BROADWAY ST
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City | BARABOO
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State | WI
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Zip | 53913-2183
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Country | US
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Telephone | 608-524-7912
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Fax | 608-524-7990
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Provider Business Mailing Address
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Address Line | 333 ARLINGTON CT
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City | SPRING GREEN
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State | WI
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Zip | 53588-8727
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Country | US
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Telephone | 608-588-7964
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3871-026
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License Number State | WI
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