Provider Demographics
NPI:1811630213
Name:GIFFORD, BAILEY (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MALABU DR APT 66
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3149
Mailing Address - Country:US
Mailing Address - Phone:270-772-2620
Mailing Address - Fax:
Practice Address - Street 1:448 LEWIS HARGETT CIR STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3900
Practice Address - Country:US
Practice Address - Phone:270-772-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist