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General NPI Number Information
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NPI Number | 1740905744
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Entity Type | Individual
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Provider Name | BRIAN KONEFSKY OTR/L
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Gender | Male
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 4545 SHELLEY CT
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City | STOCKTON
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State | CA
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Zip | 95207-7232
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Country | US
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Telephone | 209-477-0271
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Fax |
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Provider Business Mailing Address
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Address Line | 200 POND VISTA LN APT E
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City | MANHEIM
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State | PA
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Zip | 17545-9816
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Country | US
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Telephone |
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Fax |
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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 | OC018219
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License Number State | PA
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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 | 28122
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License Number State | CA
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