Provider Demographics
NPI:1295584746
Name:HYATT, BAILEY BRIAN (OTD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:BRIAN
Last Name:HYATT
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HOP RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7530
Mailing Address - Country:US
Mailing Address - Phone:707-888-8274
Mailing Address - Fax:
Practice Address - Street 1:5554 THOMAS RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9377
Practice Address - Country:US
Practice Address - Phone:415-297-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist