Provider Demographics
NPI:1750648812
Name:KONRAD, LAURA C (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:KONRAD
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 1:809 DARTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4517
Mailing Address - Country:US
Mailing Address - Phone:734-623-3204
Mailing Address - Fax:
Practice Address - Street 1:809 DARTMOOR RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4517
Practice Address - Country:US
Practice Address - Phone:734-623-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001076225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201001076OtherMICHIGAN BOARD OF OCCUPATIONAL THERAPISTS LICENCE
988055OtherNATIONAL BOARD FOR CERTIFICATION OF OCCUPATIONAL THERAPISTS