Provider Demographics
NPI:1275839565
Name:CONRAD-REINGOLD, MARY JO (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:CONRAD-REINGOLD
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:MS
Other - First Name:MARY JO
Other - Middle Name:
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 WESTFALL RD.
Mailing Address - Street 2:ARTICLE 16, MONROE DEVELOPMENTAL CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-461-8740
Mailing Address - Fax:585-461-8545
Practice Address - Street 1:620 WESTFALL RD.
Practice Address - Street 2:ARTICLE 16, MONROE DEVELOPMENTAL CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-461-8877
Practice Address - Fax:585-461-8545
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
008170-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist