Provider Demographics
NPI:1639883903
Name:BAILEY, MARJORIE SUE
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:SUE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:SUE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2820 WAGGONER BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:WINGO
Mailing Address - State:KY
Mailing Address - Zip Code:42088-8725
Mailing Address - Country:US
Mailing Address - Phone:270-804-2342
Mailing Address - Fax:
Practice Address - Street 1:2820 WAGGONER BOTTOM RD
Practice Address - Street 2:
Practice Address - City:WINGO
Practice Address - State:KY
Practice Address - Zip Code:42088-8725
Practice Address - Country:US
Practice Address - Phone:270-804-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist