Provider Demographics
NPI:1477725414
Name:BIRD, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BIRD
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 1:36000 FREMONT BLVD
Mailing Address - Street 2:APT 11
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3465
Mailing Address - Country:US
Mailing Address - Phone:650-758-4700
Mailing Address - Fax:
Practice Address - Street 1:36000 FREMONT BLVD
Practice Address - Street 2:APT 11
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3465
Practice Address - Country:US
Practice Address - Phone:650-758-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1562224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant