Provider Demographics
NPI:1104429315
Name:MAHON, TATJANA CVJETINOVIC
Entity type:Individual
Prefix:
First Name:TATJANA
Middle Name:CVJETINOVIC
Last Name:MAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TATJANA
Other - Middle Name:
Other - Last Name:CVJETINOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 GRANITE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3660
Mailing Address - Country:US
Mailing Address - Phone:203-228-1328
Mailing Address - Fax:
Practice Address - Street 1:730 CENTER ST STE 9
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6316
Practice Address - Country:US
Practice Address - Phone:207-783-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5561225XP0200X
ME4430225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics