Provider Demographics
NPI:1699942920
Name:CONRAD, ABBY L (OTR)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:L
Last Name:CONRAD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-8915
Mailing Address - Country:US
Mailing Address - Phone:217-621-2119
Mailing Address - Fax:
Practice Address - Street 1:2103 N VETERANS PKWY STE 332
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-0917
Practice Address - Country:US
Practice Address - Phone:309-585-1809
Practice Address - Fax:309-808-2572
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008080225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist