Healthcare Provider Details

I. General information

NPI: 1326117680
Provider Name (Legal Business Name): CAROL MAYO RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

67 N QUINSIGAMOND AVE UNIT 18
SHREWSBURY MA
01545-5131
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6272
  • Fax:
Mailing address:
  • Phone: 617-732-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number846
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: