Provider Demographics
NPI:1619432028
Name:KODASH, BAILEE ANNE
Entity Type:Individual
Prefix:
First Name:BAILEE
Middle Name:ANNE
Last Name:KODASH
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 1:10461 STATE ROUTE 700
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9741
Mailing Address - Country:US
Mailing Address - Phone:330-569-7831
Mailing Address - Fax:
Practice Address - Street 1:10461 STATE ROUTE 700
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9741
Practice Address - Country:US
Practice Address - Phone:330-569-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer