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General NPI Number Information
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NPI Number | 1588998793
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Entity Type | Individual
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Provider Name | LISA JAE BAILEY OT/L
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Gender | Female
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 1045 WHIPPLE ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-1662
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Country | US
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Telephone | 805-287-2944
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 W IRON SPRINGS RD LOT 64
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City | PRESCOTT
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State | AZ
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Zip | 86305-3308
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Country | US
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Telephone | 480-528-7294
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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 | 2413
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License Number State | AZ
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