Provider Demographics
NPI:1730609009
Name:MAREAN, CODY (ATC, PES)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MAREAN
Suffix:
Gender:M
Credentials:ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-0874
Mailing Address - Country:US
Mailing Address - Phone:207-756-2136
Mailing Address - Fax:
Practice Address - Street 1:11 ACADEMY LN
Practice Address - Street 2:
Practice Address - City:NORTH BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04057-1808
Practice Address - Country:US
Practice Address - Phone:207-756-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT4982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer