Healthcare Provider Details

I. General information

NPI: 1740849058
Provider Name (Legal Business Name): LAIRD HOME SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 ROSS ST
SANTA CRUZ CA
95060-2022
US

IV. Provider business mailing address

234 ROSS ST
SANTA CRUZ CA
95060-2022
US

V. Phone/Fax

Practice location:
  • Phone: 757-761-3113
  • Fax:
Mailing address:
  • Phone: 757-761-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA LAIRD BOWSER
Title or Position: OWNER
Credential: OTR/L, CAPS
Phone: 757-761-3113