Provider Demographics
NPI:1093493363
Name:LAIRD, AMY R
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:LAIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S COUNTY ROAD 17
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-9670
Mailing Address - Country:US
Mailing Address - Phone:419-618-5656
Mailing Address - Fax:
Practice Address - Street 1:390 S COUNTY ROAD 17
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-9670
Practice Address - Country:US
Practice Address - Phone:419-618-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver