Provider Demographics
NPI:1407030133
Name:ENDAL, GERHARD CONRAD (OT)
Entity Type:Individual
Prefix:MR
First Name:GERHARD
Middle Name:CONRAD
Last Name:ENDAL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FEEDER DAM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-5419
Mailing Address - Country:US
Mailing Address - Phone:518-744-9829
Mailing Address - Fax:518-792-8075
Practice Address - Street 1:90 FEEDER DAM RD
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-5419
Practice Address - Country:US
Practice Address - Phone:518-744-9829
Practice Address - Fax:518-792-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12983225X00000X
NY002200-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist