Provider Demographics
NPI:1710171152
Name:BIRD, KAREN NICOLE (MA OTRL)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:NICOLE
Last Name:BIRD
Suffix:
Gender:F
Credentials:MA OTRL
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:NICOLE
Other - Last Name:BIRD MELLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA OTRL
Mailing Address - Street 1:PO BOX 18554
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-0554
Mailing Address - Country:US
Mailing Address - Phone:440-449-8880
Mailing Address - Fax:440-449-8640
Practice Address - Street 1:5035 MAYFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2688
Practice Address - Country:US
Practice Address - Phone:440-449-8880
Practice Address - Fax:440-299-6576
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT000737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist