Provider Demographics
NPI:1821712639
Name:CONWAY, SEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:CONWAY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6904 LAUREL ISLAND PKWY APT 105
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6976
Mailing Address - Country:US
Mailing Address - Phone:508-586-1995
Mailing Address - Fax:
Practice Address - Street 1:6904 LAUREL ISLAND PKWY APT 105
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6976
Practice Address - Country:US
Practice Address - Phone:508-586-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT23483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist