Provider Demographics
NPI:1942296850
Name:CONRAD, SUSAN LOUISE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LOUISE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LOUISE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-0049
Mailing Address - Country:US
Mailing Address - Phone:319-277-3166
Mailing Address - Fax:
Practice Address - Street 1:211 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2859
Practice Address - Country:US
Practice Address - Phone:319-277-3166
Practice Address - Fax:319-266-4846
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00236224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant