Provider Demographics
NPI:1487055737
Name:LANG, MARY (MT-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LANG
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 1:176 MAIN ST APT 7
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-4024
Mailing Address - Country:US
Mailing Address - Phone:215-527-0563
Mailing Address - Fax:
Practice Address - Street 1:176 MAIN ST APT 7
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-4024
Practice Address - Country:US
Practice Address - Phone:215-527-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10623225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist