Provider Demographics
NPI:1114189511
Name:AURELIEN, MARLINE (PTA)
Entity Type:Individual
Prefix:
First Name:MARLINE
Middle Name:
Last Name:AURELIEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HIGHLAND AVE APT 12A
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4520
Mailing Address - Country:US
Mailing Address - Phone:617-820-0204
Mailing Address - Fax:
Practice Address - Street 1:1 MEADOWBROOK WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2496
Practice Address - Country:US
Practice Address - Phone:781-961-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist