Provider Demographics
NPI:1851173728
Name:BROXSON, BAILEY ANN WINTERHOF (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANN WINTERHOF
Last Name:BROXSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 NE CONNER CT
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-2308
Mailing Address - Country:US
Mailing Address - Phone:712-371-2162
Mailing Address - Fax:
Practice Address - Street 1:801 NE VENTURE DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9411
Practice Address - Country:US
Practice Address - Phone:515-415-4348
Practice Address - Fax:515-864-0223
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist