MEDICARE: MRS. LEAH A BAYLISS OT

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	OT0488	MS

General Provider Information

NPI Number	:	1588752075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH A BAYLISS OT

Provider Business Mailing Address
First Line	:	107 WILDBERRY WAY
Second Line	:
City	:	PEARL
State	:	MS
Zip	:	39208-9221
Country	:	US
Telephone Number	:	601-939-3510
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 PELAHATCHIE SHORE DR
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6282
Country	:	US
Telephone Number	:	601-613-7328
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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