Provider Demographics
NPI:1407353014
Name:BAILEY, GAIL LOUISE (LMT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LOUISE
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 1:2676 MONTARA DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-2170
Mailing Address - Country:US
Mailing Address - Phone:541-499-3014
Mailing Address - Fax:
Practice Address - Street 1:539 STEVENS ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6718
Practice Address - Country:US
Practice Address - Phone:541-499-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist