Provider Demographics
NPI:1710904586
Name:CONLEY, MARY T (MOT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5705
Mailing Address - Country:US
Mailing Address - Phone:304-242-1390
Mailing Address - Fax:304-243-5880
Practice Address - Street 1:1305 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5705
Practice Address - Country:US
Practice Address - Phone:304-242-1390
Practice Address - Fax:304-243-5880
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1123OtherWV LICENSE