Provider Demographics
NPI:1831679455
Name:BAYLY, ABIGAIL (MOTR)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BAYLY
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 DOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9773
Mailing Address - Country:US
Mailing Address - Phone:208-241-0047
Mailing Address - Fax:
Practice Address - Street 1:420 ROWE ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9319
Practice Address - Country:US
Practice Address - Phone:208-882-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-873225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist