Provider Demographics
NPI:1730849423
Name:BIRD, LISA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:BIRD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 LANMAN DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2933
Mailing Address - Country:US
Mailing Address - Phone:248-535-1865
Mailing Address - Fax:
Practice Address - Street 1:1901 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1878
Practice Address - Country:US
Practice Address - Phone:248-836-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant