Provider Demographics
NPI:1063795433
Name:CONRAD, PATRICIA L (COTA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:CONRAD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:BLOOMING GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:10914-0173
Mailing Address - Country:US
Mailing Address - Phone:845-496-2446
Mailing Address - Fax:
Practice Address - Street 1:145 TUTHILL RD
Practice Address - Street 2:
Practice Address - City:BLOOMING GROVE
Practice Address - State:NY
Practice Address - Zip Code:10914-0173
Practice Address - Country:US
Practice Address - Phone:845-496-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007648-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant