Provider Demographics
NPI:1902411218
Name:BAILEY, DOROTHY KAY
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:KAY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 S GRUBB RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-9309
Mailing Address - Country:US
Mailing Address - Phone:419-979-7519
Mailing Address - Fax:
Practice Address - Street 1:2480 S GRUBB RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-9309
Practice Address - Country:US
Practice Address - Phone:419-979-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201614Medicaid