Provider Demographics
NPI:1669204855
Name:BAILEY, EMILY (RD, LD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 TOWNSHIP ROAD 26
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9434
Mailing Address - Country:US
Mailing Address - Phone:314-629-3659
Mailing Address - Fax:
Practice Address - Street 1:3625 TOWNSHIP ROAD 26
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9434
Practice Address - Country:US
Practice Address - Phone:314-629-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.8200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered