Provider Demographics
NPI:1063678050
Name:CONRAD, ANITA LUCILE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LUCILE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAUCK DR
Mailing Address - Street 2:WINCHESTER
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-4282
Mailing Address - Country:US
Mailing Address - Phone:540-667-7830
Mailing Address - Fax:540-535-2048
Practice Address - Street 1:110 LAUCK DR
Practice Address - Street 2:WINCHESTER
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-4282
Practice Address - Country:US
Practice Address - Phone:540-667-7830
Practice Address - Fax:540-535-2048
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist