Individual
MS. EDNA LOU TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
250 INTERNATIONAL PKWY, SUITE 260, LAKE MARY, FL 32746-5030
(407) 833-8815
Mailing address
250 INTERNATIONAL PKWY, SUITE 260, LAKE MARY, FL 32746-5030
(407) 833-8815
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119004206
VA
225X00000X
Occupational Therapist
108606
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119004206
COMMONWEALTH OF VIRGINIA
VA
01
—
108606
STATE OF TEXAS
TX
Enumeration date
09/26/2007
Last updated
09/26/2007
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