Provider Demographics
NPI:1700025335
Name:BAILEY, RICHARD PRESTON (LMT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PRESTON
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W Q ST
Mailing Address - Street 2:SUITE #8
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2188
Mailing Address - Country:US
Mailing Address - Phone:541-912-1400
Mailing Address - Fax:
Practice Address - Street 1:105 W Q ST
Practice Address - Street 2:SUITE #8
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2188
Practice Address - Country:US
Practice Address - Phone:541-912-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist