Provider Demographics
NPI:1972094662
Name:BAILEY, TERRA RUTH ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:RUTH ELIZABETH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BAY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2103
Mailing Address - Country:US
Mailing Address - Phone:831-854-2060
Mailing Address - Fax:408-604-0214
Practice Address - Street 1:820 BAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2103
Practice Address - Country:US
Practice Address - Phone:831-854-2060
Practice Address - Fax:408-604-0214
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist