Provider Demographics
NPI:1255742086
Name:BAILEY, KRISTINA (OTR)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1739
Mailing Address - Country:US
Mailing Address - Phone:570-768-9452
Mailing Address - Fax:
Practice Address - Street 1:1360 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1739
Practice Address - Country:US
Practice Address - Phone:570-768-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008904225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology