Provider Demographics
NPI:1932322294
Name:CONRAD, ANNE (OTRL)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2940
Mailing Address - Country:US
Mailing Address - Phone:229-244-4545
Mailing Address - Fax:229-244-4244
Practice Address - Street 1:1701 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2940
Practice Address - Country:US
Practice Address - Phone:229-244-4545
Practice Address - Fax:229-244-4244
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGOtherWELLCARE