Provider Demographics
NPI:1205908225
Name:POULIN, MARYKAY B (OTR)
Entity type:Individual
Prefix:
First Name:MARYKAY
Middle Name:B
Last Name:POULIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-2026
Mailing Address - Country:US
Mailing Address - Phone:978-912-2656
Mailing Address - Fax:
Practice Address - Street 1:8 CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-2026
Practice Address - Country:US
Practice Address - Phone:978-912-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist