MEDICARE: LESLIE ELIZABETH TALARICO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant		OR

General Provider Information

NPI Number	:	1891307807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ELIZABETH TALARICO

Provider Business Mailing Address
First Line	:	3223 SE 118TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-1607
Country	:	US
Telephone Number	:	503-936-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 SE 118TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-1607
Country	:	US
Telephone Number	:	503-936-3368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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Directions to “ LESLIE ELIZABETH TALARICO ” Practice Location

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