Provider Demographics
NPI:1689891244
Name:OCCUPATIONAL DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:OCCUPATIONAL DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL, CDMS
Authorized Official - Phone:480-820-5526
Mailing Address - Street 1:2055 E SOUTHERN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7507
Mailing Address - Country:US
Mailing Address - Phone:480-820-5526
Mailing Address - Fax:480-820-0136
Practice Address - Street 1:2055 E SOUTHERN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7507
Practice Address - Country:US
Practice Address - Phone:480-820-5526
Practice Address - Fax:480-820-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0090225X00000X, 225XE1200X, 225XH1200X, 225XH1300X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomicsGroup - Multi-Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Not Answered225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman FactorsGroup - Multi-Specialty
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0106484OtherWA DEPT OF LABOR & INDUST
AZAZ0463260OtherBLUECROSS BLUESHIELD AZ