Provider Demographics
NPI:1407107766
Name:CONWAY, CARRIE B
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:CONWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:A
Other - Last Name:BLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:480 DONALD ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5945
Mailing Address - Country:US
Mailing Address - Phone:603-627-4147
Mailing Address - Fax:603-644-6906
Practice Address - Street 1:480 DONALD ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5945
Practice Address - Country:US
Practice Address - Phone:603-627-4147
Practice Address - Fax:603-644-6906
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1445225X00000X
MA6912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist