Provider Demographics
NPI:1841243375
Name:TALACKO, MARJORIE JEAN (OTRL CHT)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:JEAN
Last Name:TALACKO
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833
Mailing Address - Country:US
Mailing Address - Phone:978-771-6903
Mailing Address - Fax:
Practice Address - Street 1:25 SUMMER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833
Practice Address - Country:US
Practice Address - Phone:978-771-6903
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist