Healthcare Provider Details

I. General information

NPI: 1881710531
Provider Name (Legal Business Name): LAURA CONNOR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 E DIVISION ST
DIAMOND IL
60416-9486
US

IV. Provider business mailing address

5835 E NORTH PRAIRIE DR
MORRIS IL
60450-7308
US

V. Phone/Fax

Practice location:
  • Phone: 815-390-3566
  • Fax: 815-364-0161
Mailing address:
  • Phone: 815-483-3303
  • Fax: 815-531-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056006304
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: