Provider Demographics
NPI:1194080069
Name:CONLEY, MARY ALYSE (LMT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALYSE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E MAIN ST STE 30
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-6022
Mailing Address - Country:US
Mailing Address - Phone:541-973-1137
Mailing Address - Fax:
Practice Address - Street 1:107 E MAIN ST STE 30
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-6022
Practice Address - Country:US
Practice Address - Phone:541-973-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist