Provider Demographics
NPI:1588391411
Name:TANKING, CONNOR (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:TANKING
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1995
Mailing Address - Country:US
Mailing Address - Phone:785-272-7912
Mailing Address - Fax:785-272-7912
Practice Address - Street 1:3500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1995
Practice Address - Country:US
Practice Address - Phone:785-272-7912
Practice Address - Fax:785-272-7912
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03735225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist