Provider Demographics
NPI:1164876090
Name:BAILETTI, MARIA PIA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PIA
Last Name:BAILETTI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 AIRPORT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8623
Mailing Address - Country:US
Mailing Address - Phone:850-484-9292
Mailing Address - Fax:850-484-9525
Practice Address - Street 1:1108 AIRPORT BLVD STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8623
Practice Address - Country:US
Practice Address - Phone:850-484-9292
Practice Address - Fax:850-484-9525
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist