Healthcare Provider Details

I. General information

NPI: 1093493363
Provider Name (Legal Business Name): MRS. AMY R LAIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S COUNTY ROAD 17
TIFFIN OH
44883-9670
US

IV. Provider business mailing address

390 S COUNTY ROAD 17
TIFFIN OH
44883-9670
US

V. Phone/Fax

Practice location:
  • Phone: 419-618-5656
  • Fax:
Mailing address:
  • Phone: 419-618-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: