Provider Demographics
NPI:1225404718
Name:CLAY, TALYA
Entity Type:Individual
Prefix:
First Name:TALYA
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84312
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0016
Mailing Address - Country:US
Mailing Address - Phone:832-819-5699
Mailing Address - Fax:
Practice Address - Street 1:11619 COACHFIELD LN
Practice Address - Street 2:(MOBILE BUSINESS)
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0016
Practice Address - Country:US
Practice Address - Phone:832-819-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist