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General NPI Number Information
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NPI Number | 1811660301
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Entity Type | Individual
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Provider Name | KELLY MARIE BAILEY
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 34179 N PICKET POST DR
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-6649
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Country | US
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Telephone | 480-710-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 2113 W INLET LOOP
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City | MESA
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State | AZ
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Zip | 85202-5509
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Country | US
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Telephone | 218-393-7412
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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 | OTA-046711
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License Number State | AZ
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