Provider Demographics
NPI:1881710531
Name:CONNOR, LAURA (OTR)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 E NORTH PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-7308
Mailing Address - Country:US
Mailing Address - Phone:815-483-3303
Mailing Address - Fax:815-531-1075
Practice Address - Street 1:3002 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:IL
Practice Address - Zip Code:60416-9486
Practice Address - Country:US
Practice Address - Phone:815-390-3566
Practice Address - Fax:815-364-0161
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006304225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03232032OtherEARLY INTERVENTION CBO
IL0003232033OtherBLUE CROSS BLUE SHIELD