MEDICARE: LAURA CONNOR OTR

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
1	225XP0200X	Pediatric Occupational Therapist	056006304	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03232032	OTHER	IL	EARLY INTERVENTION CBO
2	0003232033	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1881710531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA CONNOR OTR

Provider Business Mailing Address
First Line	:	5835 E NORTH PRAIRIE DR
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-7308
Country	:	US
Telephone Number	:	815-483-3303
Fax Number	:	815-531-1075

Provider Business Practice Location Address
First Line	:	3002 E DIVISION ST
Second Line	:
City	:	DIAMOND
State	:	IL
Zip	:	60416-9486
Country	:	US
Telephone Number	:	815-390-3566
Fax Number	:	815-364-0161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	02/13/2024

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