Provider Demographics
NPI:1497378251
Name:CONNER, ERIN (OT, CHT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:WAGENHORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:
Practice Address - Street 1:13801 ST FRANCIS BLVD # 200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3206
Practice Address - Country:US
Practice Address - Phone:804-320-4604
Practice Address - Fax:804-287-2786
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005321225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand