Provider Demographics
NPI:1710722947
Name:CONWAY, KELLY M (MS OTR/L, BSN, RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MS OTR/L, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 JESSOP LN
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1342
Mailing Address - Country:US
Mailing Address - Phone:570-947-4854
Mailing Address - Fax:
Practice Address - Street 1:27 JESSOP LN
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-1342
Practice Address - Country:US
Practice Address - Phone:570-947-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN773792163W00000X
PAOC009187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No163W00000XNursing Service ProvidersRegistered Nurse