Provider Demographics
NPI:1861910937
Name:BOGGS, BAILEY NICOLE (OTD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:NICOLE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1090 NE GATEWAY CT NE
Practice Address - Street 2:STE 204A
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2414
Practice Address - Country:US
Practice Address - Phone:704-403-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15483225X00000X
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2255A2300XOtherCODE 22