Provider Demographics
NPI:1053629576
Name:BIRD, MARY (BS, OT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:BS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 TOQUIMA TRL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-6339
Mailing Address - Country:US
Mailing Address - Phone:046-220-3557
Mailing Address - Fax:
Practice Address - Street 1:1003 TOQUIMA TRL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-6339
Practice Address - Country:US
Practice Address - Phone:046-220-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist