MEDICARE: MARVIENNE TALLEY

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518372648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVIENNE TALLEY

Provider Business Mailing Address
First Line	:	10306 RUSSELL AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-1619
Country	:	US
Telephone Number	:	216-235-2922
Fax Number	:

Provider Business Practice Location Address
First Line	:	10306 RUSSELL AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-1619
Country	:	US
Telephone Number	:	216-235-2922
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MARVIENNE SHAWNTE TALLEY
Credential	:
Telephone Number	:	121-623-5292

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	06/27/2014

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Directions to “MARVIENNE TALLEY ” Practice Location

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