Provider Demographics
NPI:1407465560
Name:SKELTON, BAYLEE A
Entity Type:Individual
Prefix:
First Name:BAYLEE
Middle Name:A
Last Name:SKELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 BLUESTONE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6727
Mailing Address - Country:US
Mailing Address - Phone:636-896-0999
Mailing Address - Fax:
Practice Address - Street 1:2085 BLUESTONE DR STE 202
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6727
Practice Address - Country:US
Practice Address - Phone:636-896-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020005414224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020005414OtherSTATY OF MISSOURI OTA LICENSE NUMBER