Provider Demographics
NPI:1649931684
Name:CONANT, LORELEI LYNNETTE (PTA)
Entity type:Individual
Prefix:
First Name:LORELEI
Middle Name:LYNNETTE
Last Name:CONANT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LORELEI
Other - Middle Name:LYNNETTE
Other - Last Name:COVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:14 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-3453
Mailing Address - Country:US
Mailing Address - Phone:607-244-7323
Mailing Address - Fax:
Practice Address - Street 1:43 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1937
Practice Address - Country:US
Practice Address - Phone:845-337-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1184537225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant