Provider Demographics
NPI:1710267364
Name:BAILEY, LAURIE KAY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:KAY
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 1:3098 CAMBRIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-4868
Mailing Address - Country:US
Mailing Address - Phone:321-723-6126
Mailing Address - Fax:
Practice Address - Street 1:3098 CAMBRIA AVENUE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908
Practice Address - Country:US
Practice Address - Phone:321-501-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 42783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist