Provider Demographics
NPI:1770868952
Name:BAILEY, ANSLEY S (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANSLEY
Middle Name:S
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 GA HIGHWAY 26 W
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:GA
Mailing Address - Zip Code:31025-2027
Mailing Address - Country:US
Mailing Address - Phone:478-262-1084
Mailing Address - Fax:229-268-2827
Practice Address - Street 1:495 GA HIGHWAY 26 W
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:GA
Practice Address - Zip Code:31025-2027
Practice Address - Country:US
Practice Address - Phone:478-262-1084
Practice Address - Fax:229-268-2827
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005359225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114488GMedicaid
GA202I673816Medicare PIN