Provider Demographics
NPI:1861139503
Name:OLIVER, BAILEY MARIE
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:MARIE
Last Name:OLIVER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:MARIE
Other - Last Name:MAZEZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6450 OIL WELL RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-9561
Mailing Address - Country:US
Mailing Address - Phone:321-986-9561
Mailing Address - Fax:
Practice Address - Street 1:6450 OIL WELL RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-9561
Practice Address - Country:US
Practice Address - Phone:321-986-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-15
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11906235Z00000X
FLSI41392355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant