Individual
CORY BAIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
706 MEADOW AVE, TILLAMOOK, OR 97141-2844
(503) 354-2523
Mailing address
706 MEADOW AVE, TILLAMOOK, OR 97141-2844
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
519195
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
519195
MENTAL HEALTH ADULT FOSTE HOME PROVIDER
—
Enumeration date
04/02/2019
Last updated
04/02/2019
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