Provider Demographics
NPI:1952556896
Name:KONRADI, TARA JEAN (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:JEAN
Last Name:KONRADI
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-2702
Mailing Address - Country:US
Mailing Address - Phone:712-732-7395
Mailing Address - Fax:
Practice Address - Street 1:50 DEY ST
Practice Address - Street 2:#334
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5149
Practice Address - Country:US
Practice Address - Phone:712-299-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11729225X00000X
NY0151261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist