Individual
BENJAMIN CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
1526 LOMBARD ST, PHILADELPHIA, PA 19146-1625
(215) 546-5960
Mailing address
7808 GRANVILLE RD, PHILADELPHIA, PA 19128-4020
(215) 435-1947
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TOP008513
PA
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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