Provider Demographics
NPI:1225881659
Name:BAILEY, GILLIAN (LMT)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 NW SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5481
Mailing Address - Country:US
Mailing Address - Phone:541-408-0232
Mailing Address - Fax:
Practice Address - Street 1:424 NE FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4919
Practice Address - Country:US
Practice Address - Phone:541-388-3588
Practice Address - Fax:541-388-0839
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist