Provider Demographics
NPI:1992738934
Name:PRIEST, CONNIE M (OTR)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:PRIEST
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 1:8633 PRICE RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9439
Mailing Address - Country:US
Mailing Address - Phone:517-651-5951
Mailing Address - Fax:
Practice Address - Street 1:8633 PRICE RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-9439
Practice Address - Country:US
Practice Address - Phone:517-651-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist