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NPI Code Detail

MEDICARE: TODD A CONNOR OT/L

MEDICARE: TODD A CONNOR OT/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist0119-007179VA

General Provider Information

NPI Number : 1356876569
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD A CONNOR OT/L
Provider Business Mailing Address
First Line : 3512 AVOCADO DR
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23112-3485
Country : US
Telephone Number : 804-305-5567
Fax Number :
Provider Business Practice Location Address
First Line : 287 E SOUTH BLVD
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-2700
Country : US
Telephone Number : 804-733-1190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2017
Last Update Date : 04/25/2017

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Directions to “ TODD A CONNOR OT/L” Practice Location

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