Provider Demographics
NPI:1184986408
Name:BIRD, LAURA HOPE (OTR)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:HOPE
Last Name:BIRD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:HOPE
Other - Last Name:SHAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:236 BURTS RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13795-1731
Mailing Address - Country:US
Mailing Address - Phone:877-426-3307
Mailing Address - Fax:
Practice Address - Street 1:236 BURTS RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1731
Practice Address - Country:US
Practice Address - Phone:877-426-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZ6837225X00000X
NY021745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health