Provider Demographics
NPI:1700274503
Name:BAILEY, ASHLEY IRENE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:IRENE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:ELM CREEK
Mailing Address - State:NE
Mailing Address - Zip Code:68836-7680
Mailing Address - Country:US
Mailing Address - Phone:308-708-0293
Mailing Address - Fax:
Practice Address - Street 1:800 STOEGER DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4404
Practice Address - Country:US
Practice Address - Phone:308-382-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE881224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant