Provider Demographics
NPI:1447733399
Name:TALLMAN, DEIRDRE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PINE DR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1868
Mailing Address - Country:US
Mailing Address - Phone:201-782-9306
Mailing Address - Fax:
Practice Address - Street 1:29 PINE DR
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1868
Practice Address - Country:US
Practice Address - Phone:201-782-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00821000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist