Provider Demographics
NPI:1144760901
Name:VANCE, TALLI (MOTR/L)
Entity Type:Individual
Prefix:
First Name:TALLI
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 LONE TREE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72642-7130
Mailing Address - Country:US
Mailing Address - Phone:870-424-2224
Mailing Address - Fax:870-424-0493
Practice Address - Street 1:860 HIGHWAY 62 E STE 10
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3200
Practice Address - Country:US
Practice Address - Phone:870-424-2224
Practice Address - Fax:870-424-0493
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist