Provider Demographics
NPI:1497776371
Name:MANDICH, MARILYN KATHRYN (RRT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KATHRYN
Last Name:MANDICH
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:MANDICH
Other - Last Name:POLIAKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:732 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04342-4065
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:207-626-4753
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-626-4753
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METH880227900000X, 2279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Not Answered2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care