Provider Demographics
NPI:1033532627
Name:CONWAY, AVEREE ALYN (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:AVEREE
Middle Name:ALYN
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MRS
Other - First Name:AVEREE
Other - Middle Name:ALYN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:3240 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4210
Mailing Address - Country:US
Mailing Address - Phone:267-322-1805
Mailing Address - Fax:
Practice Address - Street 1:3240 MAPLE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4210
Practice Address - Country:US
Practice Address - Phone:267-322-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist