Provider Demographics
NPI:1164858999
Name:BIRD, PAULA ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANNE
Last Name:BIRD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:STAMBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:11916 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43521
Mailing Address - Country:US
Mailing Address - Phone:419-583-7439
Mailing Address - Fax:
Practice Address - Street 1:11916 COUNTY ROAD 20
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43521
Practice Address - Country:US
Practice Address - Phone:419-583-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist