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NPI Code Detail

MEDICARE: WILETTA BAILEY

MEDICARE: WILETTA 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1215708615
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILETTA BAILEY
Provider Business Mailing Address
First Line : 11720 BELTSVILLE DR # 500A15
Second Line :
City : BELTSVILLE
State : MD
Zip : 20705-3166
Country : US
Telephone Number : 202-790-8903
Fax Number :
Provider Business Practice Location Address
First Line : 11720 BELTSVILLE DR STE 500
Second Line :
City : BELTSVILLE
State : MD
Zip : 20705-3139
Country : US
Telephone Number : 202-790-8903
Fax Number : 301-889-9735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2024
Last Update Date : 01/15/2024

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Directions to “ WILETTA BAILEY ” Practice Location

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