Provider Demographics
NPI:1396047502
Name:LAIRD, STEPHANIE SMITH (OT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:SMITH
Last Name:LAIRD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:STEPHANIE
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:4720 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3321
Mailing Address - Country:US
Mailing Address - Phone:251-380-0053
Mailing Address - Fax:251-342-7928
Practice Address - Street 1:4720 MORRISON DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3321
Practice Address - Country:US
Practice Address - Phone:251-380-0053
Practice Address - Fax:251-342-7928
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist