Provider Demographics
NPI:1750802112
Name:BURKE, MARIELLEN (DIPL AC(NCCAOM))
Entity type:Individual
Prefix:
First Name:MARIELLEN
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:DIPL AC(NCCAOM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 LOWELL RD UNIT 98
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2831
Mailing Address - Country:US
Mailing Address - Phone:508-776-2025
Mailing Address - Fax:
Practice Address - Street 1:174 LOWELL RD UNIT 98
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2831
Practice Address - Country:US
Practice Address - Phone:508-776-2025
Practice Address - Fax:508-776-2025
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist