Provider Demographics
NPI:1053608125
Name:BAILEY, DEANNA LYN
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1518
Mailing Address - Country:US
Mailing Address - Phone:774-293-4421
Mailing Address - Fax:
Practice Address - Street 1:2 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1518
Practice Address - Country:US
Practice Address - Phone:774-293-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist