Provider Demographics
NPI:1497189732
Name:BAIRD, KATHRYN (COTA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 WOODED ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-5811
Mailing Address - Country:US
Mailing Address - Phone:618-407-1396
Mailing Address - Fax:
Practice Address - Street 1:4941 BENCHMARK CENTRE DR STE 300
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2038
Practice Address - Country:US
Practice Address - Phone:618-625-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL57003524224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant