Lisa Jae Bailey, OT/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2413 Issued in AZ

Practice address

1045 Whipple St
Prescott, AZ 86305-1662

Phone

(805) 287-2944

NPI assigned

Sep 22, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lisa Jae Bailey Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1588998793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 W IRON SPRINGS RD LOT 64",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863053308",
            "telephone_number": "480-528-7294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 WHIPPLE ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051662",
            "telephone_number": "805-287-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILEY",
        "first_name": "LISA",
        "middle_name": "JAE",
        "name_prefix": "Mrs.",
        "credential": "OT/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-22",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AZ",
            "license": "2413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa@kidabilitiestherapy.com",
            "affiliation": "N",
            "endpointDescription": "office",
            "address_1": "1045 Whipple St",
            "city": "Prescott",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "863051662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "BAILEY",
            "middle_name": "JAE",
            "credential": "OT/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Occupational Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.