Provider Demographics
NPI:1720068869
Name:BAIRD, STEPHANIE (AC OT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:AC OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2238
Mailing Address - Country:US
Mailing Address - Phone:207-871-5060
Mailing Address - Fax:
Practice Address - Street 1:222 ST JOHN ST
Practice Address - Street 2:SUITE 226
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-871-5060
Practice Address - Fax:207-839-2197
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC159171100000X
MEOT292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
025149OtherANTHEM BC BS OCCUPATIONAL