Provider Demographics
NPI:1730461732
Name:BAILEY, MARY HELEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 HOLTON PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4246
Mailing Address - Country:US
Mailing Address - Phone:843-810-2542
Mailing Address - Fax:
Practice Address - Street 1:1613 HOLTON PL
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4246
Practice Address - Country:US
Practice Address - Phone:843-810-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8035225X00000X
SC3850225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist