Provider Demographics
NPI:1164132379
Name:BAILEY, JASMIN SIERRA (DPT)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:SIERRA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4154
Mailing Address - Country:US
Mailing Address - Phone:815-768-7402
Mailing Address - Fax:
Practice Address - Street 1:111 SPRING ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-3332
Practice Address - Country:US
Practice Address - Phone:815-673-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026895208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation