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General NPI Number Information
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NPI Number | 1871807313
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Entity Type | Individual
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Provider Name | PATRICK BYRON BAILEY C.O.T.A.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 8641 N 67TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85302-4308
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Country | US
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Telephone | 623-939-9475
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Fax |
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Provider Business Mailing Address
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Address Line | 15231 W POST DR
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City | SURPRISE
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State | AZ
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Zip | 85374-1424
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Country | US
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Telephone | 623-466-3938
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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 | 3365
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License Number State | AR
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