Individual
MELISSA D TALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
3339 STONEWAY CT, CHAMPAIGN, IL 61822-2404
(121) 789-8663
Mailing address
3339 STONEWAY CT, CHAMPAIGN, IL 61822-2404
(121) 789-8663
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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