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BLUE BIRD OT LLC NPI 1649730045


NPI Information

NPI: 1649730045
Provider Name: BLUE BIRD OT, LLC
Classification: Clinic/Center - 261QD1600X
Entity Type: Organization

Specialization: Developmental Disabilities

Address:
501 KNIGHTS RUN AVE APT 4102
TAMPA, FL
ZIP 33602
Phone: (501) 317-8713
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BLUE BIRD OT, LLC is a developmental disabilities clinic center in Tampa, FL. The provider is an entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). BLUE BIRD OT, LLC NPI is 1649730045. The provider is registered as an organization entity type.

The provider's business location address is:

501 KNIGHTS RUN AVE APT 4102
TAMPA, FL
ZIP 33602-948
Phone: (501) 317-8713

The provider's authorized official is Brecca Lynn Michaud .
The authorized official title is Owner and has the following contact phone number (501) 317-8713.

The enumeration date for this NPI number is 3/21/2019 and was last updated on 3/21/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QD1600XClinic/CenterDevelopmental DisabilitiesYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1742945MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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