Provider Demographics
NPI:1871979278
Name:CONRAD, KIRSTIN LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:LYNN
Last Name:CONRAD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:LYNN
Other - Last Name:BRUBAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2050 HERMITAGE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-2005
Mailing Address - Country:US
Mailing Address - Phone:717-468-6955
Mailing Address - Fax:
Practice Address - Street 1:2401 RESEARCH BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:301-337-6921
Practice Address - Fax:301-657-5651
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003087L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist