Individual
EVAN CONQUEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
212 STATE RT 94 STE 2G&2H, VERNON, NJ 07462-3328
(973) 209-0086
Mailing address
135 BUTLER PKWY, SUMMIT, NJ 07901-1439
(484) 574-4957
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00802100
NJ
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
12/01/2017
Last updated
07/27/2021
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