Individual
MRS. MARIE S TALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CBIS, CRT
Contact information
Practice address
35 BEAVERSON BLVD, SUITE 4D, BRICK, NJ 08723-7812
(732) 262-7800
(732) 262-7808
Mailing address
35 BEAVERSON BLVD, SUITE 4D, BRICK, NJ 08723-7812
(732) 262-7800
(732) 262-7808
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
225400000X
Rehabilitation Practitioner
—
—
225CA2400X
Assistive Technology Practitioner Rehabilitation Counselor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
03/10/2016
Last updated
03/10/2016
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