Provider Demographics
NPI:1265892590
Name:CONROY, JOHN PAUL (OT)
Entity type:Individual
Prefix:
First Name:JOHN PAUL
Middle Name:
Last Name:CONROY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 CANOPY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-4254
Mailing Address - Country:US
Mailing Address - Phone:904-599-7634
Mailing Address - Fax:
Practice Address - Street 1:8563 ARGYLE BUSINESS LOOP
Practice Address - Street 2:SUITE #2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6668
Practice Address - Country:US
Practice Address - Phone:904-771-3679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9498225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation