Provider Demographics
NPI:1699028514
Name:BAILEY, MILISA MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MILISA
Middle Name:MARY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2674
Mailing Address - Country:US
Mailing Address - Phone:509-354-6321
Mailing Address - Fax:
Practice Address - Street 1:1001 E MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2674
Practice Address - Country:US
Practice Address - Phone:509-354-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 5335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist