Provider Demographics
NPI:1558522177
Name:BAILEY, CANDY ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CANDY
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 VISTA OAKS CIR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3108
Mailing Address - Country:US
Mailing Address - Phone:321-749-0329
Mailing Address - Fax:
Practice Address - Street 1:3214 VISTA OAKS CIR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3108
Practice Address - Country:US
Practice Address - Phone:321-749-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10529224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant