Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 321294-4201 | UT |
NPI | 1356462394 |
---|---|
Provider Name | Nichole Bernhard Conrad |
First Address | Los Angeles, CA 90051-7813 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/09/2014 |