Blue Bird OT, LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

BLUE BIRD OT, LLC

Practice address

501 Knights Run Ave Apt 4102
Tampa, FL 33602-5948

Phone

(501) 317-8713

NPI assigned

Mar 21, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brecca Lynn Michaud, MS, OTR/L

Title

Owner

Phone

(501) 317-8713

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1649730045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 KNIGHTS RUN AVE APT 4102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025948",
            "telephone_number": "501-317-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 KNIGHTS RUN AVE APT 4102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025948",
            "telephone_number": "501-317-8713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE BIRD OT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-21",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "MICHAUD",
        "authorized_official_first_name": "BRECCA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-317-8713",
        "authorized_official_credential": "MS, OTR/L"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "742945",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.