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NPI Code Detail

MEDICARE: DERRICK BAILEY

MEDICARE: DERRICK BAILEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant285318OR

General Provider Information

NPI Number : 1023431848
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK BAILEY
Provider Business Mailing Address
First Line : 6010 SW SHATTUCK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97221-1043
Country : US
Telephone Number : 503-246-8811
Fax Number :
Provider Business Practice Location Address
First Line : 6010 SW SHATTUCK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97221-1043
Country : US
Telephone Number : 503-246-8811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2014
Last Update Date : 01/30/2014

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Directions to “ DERRICK BAILEY ” Practice Location

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