MEDICARE: MARYKAY B POULIN OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1071	NH

General Provider Information

NPI Number	:	1205908225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYKAY B POULIN OTR

Provider Business Mailing Address
First Line	:	8 CARRIAGE CT
Second Line	:
City	:	MERRIMAC
State	:	MA
Zip	:	01860-2026
Country	:	US
Telephone Number	:	978-912-2656
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CARRIAGE CT
Second Line	:
City	:	MERRIMAC
State	:	MA
Zip	:	01860-2026
Country	:	US
Telephone Number	:	978-912-2656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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Directions to “ MARYKAY B POULIN OTR” Practice Location

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