Provider Demographics
NPI:1871524298
Name:BIRD, SUSAN C (OT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:BIRD
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25117 SW PARKWAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:971-255-4079
Mailing Address - Fax:
Practice Address - Street 1:N3708 RIVER AVE
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-7218
Practice Address - Country:US
Practice Address - Phone:715-743-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-03-04
Deactivation Date:2021-01-15
Deactivation Code:
Reactivation Date:2021-02-11
Provider Licenses
StateLicense IDTaxonomies
CO0000738225XP0019X
FLPA9104022363A00000X
WI8833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11282851Medicaid
CO803138Medicare ID - Type Unspecified
CO11282851Medicaid