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General NPI Number Information
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NPI Number | 1407030133
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Entity Type | Individual
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Provider Name | GERHARD CONRAD ENDAL OT
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Gender | Male
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 90 FEEDER DAM RD
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City | SOUTH GLENS FALLS
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State | NY
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Zip | 12803-5419
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Country | US
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Telephone | 518-744-9829
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Fax | 518-792-8075
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Provider Business Mailing Address
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Address Line | 90 FEEDER DAM RD
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City | SOUTH GLENS FALLS
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State | NY
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Zip | 12803-5419
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Country | US
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Telephone | 518-744-9829
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Fax | 518-792-8075
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12983
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 002200-1
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License Number State | NY
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