Provider Demographics
NPI:1942703855
Name:BAIRD, NICHOLA N
Entity Type:Individual
Prefix:MRS
First Name:NICHOLA
Middle Name:N
Last Name:BAIRD
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 1:2647 NW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6476
Mailing Address - Country:US
Mailing Address - Phone:207-592-6617
Mailing Address - Fax:
Practice Address - Street 1:2647 NW 33RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-6476
Practice Address - Country:US
Practice Address - Phone:207-592-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid