Provider Demographics
NPI:1740664903
Name:BAILEY, SARAH ANN (OTA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 W BERTRAND RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-8662
Mailing Address - Country:US
Mailing Address - Phone:269-362-7501
Mailing Address - Fax:
Practice Address - Street 1:3190 W BERTRAND RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-8662
Practice Address - Country:US
Practice Address - Phone:269-362-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000921A174400000X
MI5202005349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist