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General NPI Number Information
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NPI Number | 1750965018
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Entity Type | Individual
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Provider Name | BAILEY NICHOLS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 2001 KIRKWOOD BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1590
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Country | US
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Telephone | 817-756-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 280 W RENNER RD APT 2326
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City | RICHARDSON
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State | TX
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Zip | 75080-1355
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Country | US
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Telephone | 817-629-0053
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 216770
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License Number State | TX
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