Provider Demographics
NPI:1710109343
Name:CONRAD, KATHRYN JOYCE (MOT, OTR-L)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JOYCE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MOT, OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 DESOTO STREET
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127
Mailing Address - Country:US
Mailing Address - Phone:651-331-1634
Mailing Address - Fax:
Practice Address - Street 1:333 NORTH SMITH AVENUE
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-241-8523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103399225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist