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General NPI Number Information
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NPI Number | 1669784302
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Entity Type | Individual
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Provider Name | MRS. TAMMY REBECCA MANDIGO
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Gender | Female
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | 38 WHIPPLE RD
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City | SOUTH HERO
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State | VT
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Zip | 05486-4900
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Country | US
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Telephone | 802-732-4020
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Fax |
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Provider Business Mailing Address
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Address Line | 254 HEATH ROAD TAMMY MANDIGO
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City | SOUTH HERO
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State | VT
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Zip | 05486-4900
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Country | US
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Telephone | 802-730-8095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number | 025.0008399
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License Number State | VT
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