Individual
MARILYN (LYNN) G TEALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1248 SUSSEX TPK, UNIT B11, RANDOLPH, NJ 07869
(973) 440-8370
Mailing address
30 PETERSBURG RD, HACKETTSTOWN, NJ 07840-4902
(845) 473-0468
(845) 625-1482
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2004AF
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004AF
CERTIFICATION
MD
Enumeration date
06/24/2019
Last updated
06/24/2019
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