Provider Demographics
NPI:1407581473
Name:GUYMON, BAILEE ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BAILEE
Middle Name:ANNE
Last Name:GUYMON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E MURRAY HOLLADAY RD APT 208
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5329
Mailing Address - Country:US
Mailing Address - Phone:916-521-6445
Mailing Address - Fax:
Practice Address - Street 1:960 BOONE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1527
Practice Address - Country:US
Practice Address - Phone:877-367-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR473279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR473279OtherSTATE OF OREGON OCCUPATIONAL THERAPY LICENSING BOARD