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Individual

KELLY TALTY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
2521 80TH PL, KENOSHA, WI 53143-6203
(262) 813-0153
Mailing address
2521 80TH PL, KENOSHA, WI 53143-6203
(262) 813-0153

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary

Other

Enumeration date
05/13/2008
Last updated
11/16/2009
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