Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1386254167 |
---|---|
Provider Name | Courtney Conrad |
First Address | Carpinteria, CA 93013-2438 |
Second Address | Ventura, CA 93003-6523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 03/09/2020 |