Provider Demographics
NPI:1841766466
Name:LAIRSON, BAILEY RAY
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:RAY
Last Name:LAIRSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 QUAKER WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2499
Mailing Address - Country:US
Mailing Address - Phone:937-522-5015
Mailing Address - Fax:
Practice Address - Street 1:1870 QUAKER WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2499
Practice Address - Country:US
Practice Address - Phone:937-522-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer