Provider Demographics
NPI:1710200159
Name:BAILEY, KARRI LAINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:KARRI
Middle Name:LAINE
Last Name: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 1:358 SE CLAIRE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3759
Mailing Address - Country:US
Mailing Address - Phone:541-440-3034
Mailing Address - Fax:
Practice Address - Street 1:358 SE CLAIRE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3759
Practice Address - Country:US
Practice Address - Phone:541-440-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4455225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist