Provider Demographics
NPI:1710912597
Name:CONDER, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CONDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 PECAN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:RUDY
Mailing Address - State:AR
Mailing Address - Zip Code:72952-9026
Mailing Address - Country:US
Mailing Address - Phone:479-632-6337
Mailing Address - Fax:479-632-5916
Practice Address - Street 1:3918 PECAN GROVE RD
Practice Address - Street 2:
Practice Address - City:RUDY
Practice Address - State:AR
Practice Address - Zip Code:72952-9026
Practice Address - Country:US
Practice Address - Phone:479-632-6337
Practice Address - Fax:479-632-5916
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR752225X00000X
OK998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U246OtherBLUE CROSS B.S. PROV.#