Provider Demographics
NPI:1801400700
Name:BAIRD, MAILANIE CONCEPCION (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:MAILANIE
Middle Name:CONCEPCION
Last Name:BAIRD
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 PAUL COURTER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1706
Mailing Address - Country:US
Mailing Address - Phone:408-799-2126
Mailing Address - Fax:
Practice Address - Street 1:100 FRANK RICHARDSON CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5410
Practice Address - Country:US
Practice Address - Phone:916-423-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7750225XN1300X, 225XP0019X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120489OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS
201811202OtherHAND THERAPY CERTIFICATION COMISSION, INC
1069231OtherNATIONAL BOARD OF OCCUPATIONAL THERAPY
CAOT7750OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY
LAOTT.200047OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS