Provider Demographics
NPI:1285941278
Name:SIPA, CONRAD RICHARD (OTR/L)
Entity type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:RICHARD
Last Name:SIPA
Suffix:
Gender:M
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 1:142 E 16TH ST
Mailing Address - Street 2:APT 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3506
Mailing Address - Country:US
Mailing Address - Phone:347-414-4917
Mailing Address - Fax:
Practice Address - Street 1:142 E 16TH ST
Practice Address - Street 2:APT 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3506
Practice Address - Country:US
Practice Address - Phone:347-414-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009993-1225X00000X, 225XN1300X, 225XP0019X, 225XP0200X
NY009993225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology