Provider Demographics
NPI:1073966305
Name:TALLEY, BRITTANY (ATC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 SWEETBIRCH DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4856
Mailing Address - Country:US
Mailing Address - Phone:937-361-9190
Mailing Address - Fax:
Practice Address - Street 1:4933 SWEETBIRCH DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-4856
Practice Address - Country:US
Practice Address - Phone:937-361-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.049912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer