Provider Demographics
NPI:1669044483
Name:KUDRNA, BAILEY E (COTA/L)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:E
Last Name:KUDRNA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:GORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:12031 SHADY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-5668
Mailing Address - Country:US
Mailing Address - Phone:573-823-7694
Mailing Address - Fax:
Practice Address - Street 1:12031 SHADY CREEK DR
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-5668
Practice Address - Country:US
Practice Address - Phone:573-823-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216225224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant