Provider Demographics
NPI:1629407358
Name:MALLOCH BAILEY, KARYN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KARYN
Middle Name:
Last Name:MALLOCH BAILEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E RADISON RUN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-3831
Mailing Address - Country:US
Mailing Address - Phone:302-563-3443
Mailing Address - Fax:
Practice Address - Street 1:5609 DUPONT PKWY STE 7
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-9211
Practice Address - Country:US
Practice Address - Phone:302-563-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT0003409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEMT0003409OtherLICENSE