Provider Demographics
NPI:1518503408
Name:HUBERT, BAILEE ANNA (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:BAILEE
Middle Name:ANNA
Last Name:HUBERT
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 1:1788 POPLAR RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6318
Mailing Address - Country:US
Mailing Address - Phone:540-273-9052
Mailing Address - Fax:
Practice Address - Street 1:8020 RIVER STONE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8761
Practice Address - Country:US
Practice Address - Phone:540-834-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist