Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 31-003843A | IN |
NPI | 1235220435 |
---|---|
Provider Name | Mrs. Erin L Bailey |
First Address | Lakeville, IN 46536-9446 |
Second Address | South Bend, IN 46615-3723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000356662 | ANTHEM (01) | IN |