Provider Demographics
NPI:1669972923
Name:LAIRD, MARIAH EVELYN (MSOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:EVELYN
Last Name:LAIRD
Suffix:
Gender:F
Credentials:MSOT, OTR/L
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Other - First Name:
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Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:175 MARKET PLACE DR STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-4471
Practice Address - Country:US
Practice Address - Phone:502-251-7002
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
KY240482225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics