Provider Demographics
NPI:1588194591
Name:CONANT, MARY (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CONANT
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 1:65 W MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-5028
Mailing Address - Country:US
Mailing Address - Phone:603-860-9286
Mailing Address - Fax:
Practice Address - Street 1:203 LOWELL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-4909
Practice Address - Country:US
Practice Address - Phone:603-816-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist