Provider Demographics
NPI:1245887991
Name:BAILEY, KYLE (OTD, OTR/L, CHT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:OTD, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 MARY LOU ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2734
Mailing Address - Country:US
Mailing Address - Phone:330-807-0691
Mailing Address - Fax:
Practice Address - Street 1:3838 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7964
Practice Address - Country:US
Practice Address - Phone:330-899-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097509225XH1200X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand