Provider Demographics
NPI:1013373828
Name:CONWAY, MARIKA PATRICIA (ATC)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:PATRICIA
Last Name:CONWAY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-4221
Mailing Address - Country:US
Mailing Address - Phone:978-430-0316
Mailing Address - Fax:
Practice Address - Street 1:4 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-4221
Practice Address - Country:US
Practice Address - Phone:978-430-0316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer