Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | ||
N | 225CA2400X | Assistive Technology Practitioner |
NPI | 1508227026 |
---|---|
Provider Name | Mrs. Marie S Tallard |
First Address | Brick, NJ 08723-7812 |
Second Address | Brick, NJ 08723-7812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2016 |
Last Update Date | 10/03/2016 |