Provider Demographics
NPI:1386314276
Name:CONWAY, SETH (ATC)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:CONWAY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1913
Mailing Address - Country:US
Mailing Address - Phone:603-631-1142
Mailing Address - Fax:
Practice Address - Street 1:44 GEREMONTY DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3389
Practice Address - Country:US
Practice Address - Phone:603-893-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0420OtherNEW HAMPSHIRE BOARD OF ALLIED HEALTH