MEDICARE: BAILEY NICOLE PRATER

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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1518765411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY NICOLE PRATER

Provider Business Mailing Address
First Line	:	2376 HAVERSTICK SCHOOL RD
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-3493
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 INDUSTRIAL DR
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4134
Country	:	US
Telephone Number	:	636-933-1162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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Directions to “ BAILEY NICOLE PRATER ” Practice Location

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