Provider Demographics
NPI:1073017240
Name:SEGAL, BAILA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BAILA
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BAILI
Other - Middle Name:
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:149 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5144
Mailing Address - Country:US
Mailing Address - Phone:848-667-0967
Mailing Address - Fax:
Practice Address - Street 1:1351 OLD FREEHOLD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2775
Practice Address - Country:US
Practice Address - Phone:732-240-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00806800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist