Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 0715002953 | VA |
N | 225C00000X | Rehabilitation Counselor | 00009591 | VA |
NPI | 1104129923 |
---|---|
Provider Name | Dr. Marianne Boots Talbot |
First Address | Arlington, VA 22205-1003 |
Second Address | Arlington, VA 22205-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2010 |
Last Update Date | 16/12/2010 |