MEDICARE: TERRI BERTHA BAILEY OTR/L, OTD

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	01875	MD

General Provider Information

NPI Number	:	1740754647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI BERTHA BAILEY OTR/L, OTD

Provider Business Mailing Address
First Line	:	12000 OTHMAN CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6068
Country	:	US
Telephone Number	:	301-404-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 OTHMAN CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6068
Country	:	US
Telephone Number	:	301-404-1800
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	06/11/2019

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