Organization
BLUE BIRD OT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRECCA LYNN MICHAUD MS, OTR/L (OWNER)
(501) 317-8713
Entity
Organization
Contact information
Practice address
501 KNIGHTS RUN AVE APT 4102, TAMPA, FL 33602-5948
(501) 317-8713
Mailing address
501 KNIGHTS RUN AVE APT 4102, TAMPA, FL 33602-5948
(501) 317-8713
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
742945
—
FL
Enumeration date
03/21/2019
Last updated
03/21/2019
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