Provider Demographics
NPI:1124897582
Name:RAWLEY, MARY ELIZABETH (MT-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:RAWLEY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4040
Mailing Address - Country:US
Mailing Address - Phone:609-994-7552
Mailing Address - Fax:
Practice Address - Street 1:250 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 115
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2742
Practice Address - Country:US
Practice Address - Phone:610-449-9669
Practice Address - Fax:610-449-5566
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18095225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist