Provider Demographics
NPI:1346737343
Name:BAYCI, ANGELINE L (OTRL)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:L
Last Name:BAYCI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 PRENTIS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3455
Mailing Address - Country:US
Mailing Address - Phone:248-930-0786
Mailing Address - Fax:
Practice Address - Street 1:5021 PRENTIS DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3455
Practice Address - Country:US
Practice Address - Phone:248-930-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
5201000497225X00000X
MI5201000497225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201000497Medicaid